Healthcare Provider Details

I. General information

NPI: 1922025477
Provider Name (Legal Business Name): SVETLANA GRINTSVAYG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR STE C217
LA JOLLA CA
92037-1712
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100 SUITE 202
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 855-501-1004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number134032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: