Provider Demographics
NPI:1801195821
Name:LORD, GARY L (PHD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:LORD
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 1:802 OLDE HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4932
Mailing Address - Country:US
Mailing Address - Phone:717-735-0690
Mailing Address - Fax:717-735-0691
Practice Address - Street 1:51 FARMLAND RD
Practice Address - Street 2:
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-1907
Practice Address - Country:US
Practice Address - Phone:717-556-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004062L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist