Provider Demographics
NPI:1346271079
Name:GEVIRTZ, RICHARD NEIL (PHD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:NEIL
Last Name:GEVIRTZ
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 1:10455 POMERADO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131
Mailing Address - Country:US
Mailing Address - Phone:858-635-4842
Mailing Address - Fax:858-635-4482
Practice Address - Street 1:10455 POMERADO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131
Practice Address - Country:US
Practice Address - Phone:858-635-4842
Practice Address - Fax:858-635-4482
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7204103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical