Provider Demographics
NPI:1619180049
Name:CASON, GREGORY LAWRENCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LAWRENCE
Last Name:CASON
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 1:8581 SANTA MONICA BLVD # 221
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4120
Mailing Address - Country:US
Mailing Address - Phone:310-652-0031
Mailing Address - Fax:425-944-0918
Practice Address - Street 1:566 S SAN VICENTE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4650
Practice Address - Country:US
Practice Address - Phone:310-652-0031
Practice Address - Fax:425-944-0918
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15781103TB0200X, 103TC0700X, 103TC1900X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth