Provider Demographics
NPI:1710396262
Name:GERSON, ALLAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:GERSON
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 1:4935 LIBBIT AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1205
Mailing Address - Country:US
Mailing Address - Phone:818-416-8078
Mailing Address - Fax:818-995-8358
Practice Address - Street 1:12520 MAGNOLIA BLVD STE 302
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-2353
Practice Address - Country:US
Practice Address - Phone:818-416-8078
Practice Address - Fax:818-995-8358
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3338103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical