Active NPI
Michele Marie Jean-Gilles, PHD
- Clinical Psychologist
- Hollywood, FL
National Provider Identifier
1366630428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY5592
- Practice address
- 1909 Tyler St
Suite 504
Hollywood, FL 33020-4527 - Phone
- (954) 929-7515
- Fax
- (954) 929-7510
- NPI assigned
- Oct 12, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY5592 | FL | Primary |
Addresses
Primary practice location
1909 Tyler St
Suite 504
Hollywood, FL 33020-4527
Mailing address
1909 Tyler St
Suite 504
Hollywood, FL 33020-4527
Phone (954) 929-7515
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 767892400 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY5592 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192147200000",
"number": "1366630428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1909 TYLER ST",
"address_2": "SUITE 504",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330204527",
"telephone_number": "954-929-7515",
"fax_number": "954-929-7510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1909 TYLER ST",
"address_2": "SUITE 504",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330204527",
"telephone_number": "954-929-7515",
"fax_number": "954-929-7510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEAN-GILLES",
"first_name": "MICHELE",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-12",
"last_updated": "2007-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY5592",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "767892400",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hollywood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.