Provider Demographics
NPI:1619940178
Name:GASPERONI, JOHN LINO (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LINO
Last Name:GASPERONI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3050 CITRUS CIR STE 202
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2662
Mailing Address - Country:US
Mailing Address - Phone:925-279-1046
Mailing Address - Fax:925-279-1146
Practice Address - Street 1:3050 CITRUS CIRCLE
Practice Address - Street 2:SUITE 202
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2662
Practice Address - Country:US
Practice Address - Phone:925-279-1046
Practice Address - Fax:925-279-1146
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11734103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL117341Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST