Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY12636 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSY12636 | CA |
Y | 103G00000X | Clinical Psychologist | PSY12636 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY12636 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY12636 | CA |
N | 103TF0000X | Family Psychologist | PSY12636 | CA |
N | 103TP0814X | Psychoanalysis | PSY12636 | CA |
N | 103TP2701X | Group Psychotherapist | PSY12636 | CA |
NPI | 1316187743 |
---|---|
Provider Name | Dr. Gregory Gerard Gurnick |
First Address | Berkeley, CA 94709-0501 |
Second Address | Berkeley, CA 94707-2406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2009 |
Last Update Date | 24/01/2011 |