Provider Demographics
NPI:1457309882
Name:GERSON, MICHAEL JOEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOEL
Last Name:GERSON
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 1:32129 LINDERO CANYON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4207
Mailing Address - Country:US
Mailing Address - Phone:818-707-3905
Mailing Address - Fax:818-889-4175
Practice Address - Street 1:32129 LINDERO CANYON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4207
Practice Address - Country:US
Practice Address - Phone:818-707-3905
Practice Address - Fax:818-889-4175
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8785103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical