Provider Demographics
NPI:1154551505
Name:QUIMBY, GERALD RICHARD (PSYD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:RICHARD
Last Name:QUIMBY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BODIN CIR
Mailing Address - Street 2:
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:214 ROLLING SAGE CIR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-9593
Practice Address - Country:US
Practice Address - Phone:808-892-2501
Practice Address - Fax:808-892-2721
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5487101YM0800X
RIPS01312103T00000X
FLPY11891103T00000X
VA0810007982103T00000X
HIPSY1338103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN