Provider Demographics
NPI:1497886394
Name:GORDON W CARAS PH D A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:GORDON W CARAS PH D A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:CARAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-208-3589
Mailing Address - Street 1:1907 ESTRELLA DE MAR CT UNIT D
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-6125
Mailing Address - Country:US
Mailing Address - Phone:858-208-3589
Mailing Address - Fax:
Practice Address - Street 1:1907 ESTRELLA DE MAR CT UNIT D
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-6125
Practice Address - Country:US
Practice Address - Phone:858-208-3589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty