Healthcare Provider Details

I. General information

NPI: 1619544871
Provider Name (Legal Business Name): GARY ORLANDO LONS MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 CARMEL DR APT 203
WALNUT CREEK CA
94596-4244
US

IV. Provider business mailing address

1770 CARMEL DR APT 203
WALNUT CREEK CA
94596-4244
US

V. Phone/Fax

Practice location:
  • Phone: 415-524-9583
  • Fax:
Mailing address:
  • Phone: 415-524-9583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number84203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: