Provider Demographics
NPI:1235100959
Name:VERNON, GERALD ALLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ALLEN
Last Name:VERNON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14185 MANGO DR
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2924
Mailing Address - Country:US
Mailing Address - Phone:619-553-0426
Mailing Address - Fax:619-553-8945
Practice Address - Street 1:50 ROSECRANS ST
Practice Address - Street 2:BLDG 500
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-4408
Practice Address - Country:US
Practice Address - Phone:619-553-0426
Practice Address - Fax:619-553-8945
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5995103TA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical