Individual
DR. GARY A BLANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2455 BENNETT VALLEY RD, SUITE 208B, SANTA ROSA, CA 95404-5663
(707) 526-2525
(707) 526-2593
Mailing address
2455 BENNETT VALLEY RD, SUITE 208B, SANTA ROSA, CA 95404-5663
(707) 526-2525
(707) 526-2593
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY3303
CA
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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