MEDICARE: KATHY J GILBERT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	LCS12657	CA

General Provider Information

NPI Number	:	1588770945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY J GILBERT LCSW

Provider Business Mailing Address
First Line	:	3435 CAMINO DEL RIO S
Second Line	:	STE 122
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3910
Country	:	US
Telephone Number	:	619-574-0677
Fax Number	:	858-695-9823

Provider Business Practice Location Address
First Line	:	3435 CAMINO DEL RIO S
Second Line	:	STE 122
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3910
Country	:	US
Telephone Number	:	619-574-0677
Fax Number	:	858-695-9823

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	11/20/2018

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