Healthcare Provider Details

I. General information

NPI: 1699206896
Provider Name (Legal Business Name): NANCY GRAIES PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W CALIFORNIA BLVD STE 221
PASADENA CA
91105-3032
US

IV. Provider business mailing address

1009 N PACIFIC AVE UNIT 4065
GLENDALE CA
91202-2313
US

V. Phone/Fax

Practice location:
  • Phone: 818-272-8753
  • Fax: 747-271-5968
Mailing address:
  • Phone: 818-272-8753
  • Fax: 747-271-5968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: