Healthcare Provider Details

I. General information

NPI: 1578902052
Provider Name (Legal Business Name): MARK WERNER GRASSINGER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 WEST LN
STOCKTON CA
95210-3377
US

IV. Provider business mailing address

7373 WEST LN
STOCKTON CA
95210-3377
US

V. Phone/Fax

Practice location:
  • Phone: 209-476-5445
  • Fax: 209-476-3528
Mailing address:
  • Phone: 209-476-5445
  • Fax: 209-476-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS29352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: