Provider Demographics
NPI:1750933214
Name:MARK T. GMOSER, PSY.D., A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:MARK T. GMOSER, PSY.D., A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GMOSER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-821-0095
Mailing Address - Street 1:PO BOX 5306
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-5306
Mailing Address - Country:US
Mailing Address - Phone:818-821-0095
Mailing Address - Fax:
Practice Address - Street 1:7907 CHERRYSTONE AVE
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-6105
Practice Address - Country:US
Practice Address - Phone:818-821-0095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health