Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PSY9110 | CA |
NPI | 1083775704 |
---|---|
Provider Name | Dr. Gilbert Lanese |
First Address | Berkeley, CA 94702-1200 |
Second Address | Vallejo, CA 94590-4511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |