Provider Demographics
NPI:1295822674
Name:TRAUB, GARY S (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:TRAUB
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 1:6000 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2226
Mailing Address - Country:US
Mailing Address - Phone:954-202-6200
Mailing Address - Fax:954-202-6207
Practice Address - Street 1:6000 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2226
Practice Address - Country:US
Practice Address - Phone:954-202-6200
Practice Address - Fax:954-202-6207
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3620103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical