Provider Demographics
NPI:1386972578
Name:LOMAX, GARY L (MSW)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:L
Last Name:LOMAX
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 BONVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-5146
Mailing Address - Country:US
Mailing Address - Phone:415-824-3561
Mailing Address - Fax:415-641-9162
Practice Address - Street 1:45 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6017
Practice Address - Country:US
Practice Address - Phone:415-551-1789
Practice Address - Fax:415-641-9162
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS61491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22155ZMedicare UPIN