1972643674 NPI number — MR. JEFFREY D GILL LCSW

Table of content: MR. JEFFREY D GILL LCSW (NPI 1972643674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972643674 NPI number — MR. JEFFREY D GILL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILL
Provider First Name:
JEFFREY
Provider Middle Name:
D
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972643674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34760-1225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-877-8074
Provider Business Mailing Address Fax Number:
407-877-0410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N TUBB ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34760-9055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-877-8074
Provider Business Practice Location Address Fax Number:
407-674-2279
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  SW0003983 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: SW3983 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 130088500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008236600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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