Provider Demographics
NPI:1578946646
Name:CARAS, GORDON (PHD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:CARAS
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 1:1907 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:858-208-8539
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:858-208-8539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14962103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist