Provider Demographics
NPI:1265268940
Name:BANCROFT, PAUL LAWRENCE
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:LAWRENCE
Last Name:BANCROFT
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 1:913 SAN RAMON VALLEY BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4031
Mailing Address - Country:US
Mailing Address - Phone:215-915-8065
Mailing Address - Fax:
Practice Address - Street 1:913 SAN RAMON VALLEY BLVD STE 180
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4031
Practice Address - Country:US
Practice Address - Phone:215-915-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist