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General NPI Number Information
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NPI Number | 1902180441
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Entity Type | Individual
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Provider Name | LESLIE MADOLORA GILMORE LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 4400 ALMA AVE
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-3104
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Country | US
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Telephone | 510-736-5078
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Fax |
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Provider Business Mailing Address
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Address Line | 19624 ADAIR DR
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-3306
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Country | US
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Telephone | 510-736-5078
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 66151
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License Number State | CA
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