Provider Demographics
NPI:1215982632
Name:LANCASTER, GARY ROBERT (PSY)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ROBERT
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2080
Mailing Address - Street 2:MACT HEALTH BOARD INC
Mailing Address - City:TUOLUMNE
Mailing Address - State:CA
Mailing Address - Zip Code:95379-2080
Mailing Address - Country:US
Mailing Address - Phone:209-928-4278
Mailing Address - Fax:209-928-3636
Practice Address - Street 1:18396 TUOLUMNE ROAD
Practice Address - Street 2:SUITE 9
Practice Address - City:TUOLUMNE
Practice Address - State:CA
Practice Address - Zip Code:95379
Practice Address - Country:US
Practice Address - Phone:209-928-4816
Practice Address - Fax:209-928-3636
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4671103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist