Provider Demographics
NPI:1720379175
Name:PLASKETT, GARY ARCHIE
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ARCHIE
Last Name:PLASKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1309
Mailing Address - Country:US
Mailing Address - Phone:707-330-4825
Mailing Address - Fax:707-747-1391
Practice Address - Street 1:591 CAPITOL DR
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510
Practice Address - Country:US
Practice Address - Phone:707-330-4825
Practice Address - Fax:707-747-1391
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health