Healthcare Provider Details

I. General information

NPI: 1619180049
Provider Name (Legal Business Name): GREGORY LAWRENCE CASON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 S SAN VICENTE BLVD STE 201
LOS ANGELES CA
90048-4650
US

IV. Provider business mailing address

8581 SANTA MONICA BLVD # 221
WEST HOLLYWOOD CA
90069-4120
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-0031
  • Fax: 425-944-0918
Mailing address:
  • Phone: 310-652-0031
  • Fax: 425-944-0918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY15781
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15781
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY15781
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY15781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: