Provider Demographics
NPI:1295925683
Name:GILMAN, JAN LEVINSON (PHD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:LEVINSON
Last Name:GILMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3902
Mailing Address - Country:US
Mailing Address - Phone:707-483-8866
Mailing Address - Fax:
Practice Address - Street 1:718 SPRING ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3902
Practice Address - Country:US
Practice Address - Phone:707-483-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12926103TC0700X
CAMFT 7020106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical