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General NPI Number Information
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NPI Number | 1154081297
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Entity Type | Individual
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Provider Name | JOSEPH MICHAEL GRADY PSYD, LMFT
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Gender | Male
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Dates
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Enumeration Date | 12/29/2021
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 4305 GESNER ST STE 207
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City | SAN DIEGO
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State | CA
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Zip | 92117-6685
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Country | US
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Telephone | 619-535-8527
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Fax |
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Provider Business Mailing Address
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Address Line | 715 COHASSET CT APT 2
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City | SAN DIEGO
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State | CA
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Zip | 92109-8122
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Country | US
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Telephone | 608-436-6578
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 99955
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License Number State | CA
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