Healthcare Provider Details

I. General information

NPI: 1760062012
Provider Name (Legal Business Name): GILBERT JEW PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S 52ND ST STE 207
TEMPE AZ
85281-7226
US

IV. Provider business mailing address

520 S 52ND ST STE 207
TEMPE AZ
85281-7226
US

V. Phone/Fax

Practice location:
  • Phone: 602-834-4316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number005284
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: