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General NPI Number Information
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NPI Number | 1306927926
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Entity Type | Individual
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Provider Name | JASON GILLARD MSW
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 21529 SATICOY ST APT 206
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City | CANOGA PARK
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State | CA
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Zip | 91304-4962
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Country | US
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Telephone | 818-521-3867
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Fax |
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Provider Business Mailing Address
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Address Line | 21529 SATICOY ST UNIT 206
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City | CANOGA PARK
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State | CA
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Zip | 91304-4958
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14881
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 25769
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License Number State | CA
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