Provider Demographics
NPI:1740218502
Name:DRUCKER, GERALD M (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:M
Last Name:DRUCKER
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 1:350 E STREET
Mailing Address - Street 2:SUITE 404
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501
Mailing Address - Country:US
Mailing Address - Phone:707-445-8331
Mailing Address - Fax:
Practice Address - Street 1:350 E ST
Practice Address - Street 2:SUITE 404
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0357
Practice Address - Country:US
Practice Address - Phone:707-445-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10805103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 10805OtherPSYCHOLOGIST LICENSE #