MEDICARE: CARRIE ELIZABETH GRABASKAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701009686	VA
2	101YP2500X	Professional Counselor	12599	CA

General Provider Information

NPI Number	:	1437768934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE ELIZABETH GRABASKAS

Provider Business Mailing Address
First Line	:	PO BOX 18901
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95158-8901
Country	:	US
Telephone Number	:	434-219-5005
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 CHARTER PARK CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95136-1386
Country	:	US
Telephone Number	:	434-219-5005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2020
Last Update Date	:	01/27/2024

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