Provider Demographics
NPI:1265174940
Name:ENDELMAN, GREGORY (LEP)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:ENDELMAN
Suffix:
Gender:M
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12340 SEAL BEACH BLVD STE B #141
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2794
Mailing Address - Country:US
Mailing Address - Phone:714-366-1079
Mailing Address - Fax:
Practice Address - Street 1:1401 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2523
Practice Address - Country:US
Practice Address - Phone:657-321-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2772103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist