Doctor Name: | PATRICIA GRADY |
NPI Number: | 1932566098 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | 27151 |
Business Practice Address: | 8116 Hearthstone Pl Antelope, CA - 958434620 |
Business Phone Number: | 9167258716 |
Business Fax Number: | |
Mailing Address: | 8116 Hearthstone Pl, ANTELOPE |
State: | CA |
Postal Code: | 958434620 |
Phone Number: | 9167258716 |
Fax Number: | |
NPI Enumeration Date: | 01/20/2016 |
NPI Last Update Date: | 01/20/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | 27151 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |