Provider Demographics
NPI:1922494111
Name:S. W. GERE INC.
Entity Type:Organization
Organization Name:S. W. GERE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-815-8585
Mailing Address - Street 1:1252 RUBENSTEIN AVE
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-2408
Mailing Address - Country:US
Mailing Address - Phone:760-815-8585
Mailing Address - Fax:
Practice Address - Street 1:2382 FARADAY AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7218
Practice Address - Country:US
Practice Address - Phone:760-815-8585
Practice Address - Fax:760-230-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15773103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP 15773-A CAMedicare PIN