=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235162652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VRABEL PSYCHOLOGICAL SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 W BENNETT AVE SUITE -4
-----------------------------------------------------
City | GLENDORA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91741-2568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-963-2513
-----------------------------------------------------
Fax | 626-963-6630
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 W BENNETT AVE SUITE -4
-----------------------------------------------------
City | GLENDORA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91741-2568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-963-2513
-----------------------------------------------------
Fax | 626-963-6630
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. GLENN FRANCIS VRABEL
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 626-963-2513
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY20352
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------