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General NPI Number Information
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NPI Number | 1467666420
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Entity Type | Individual
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Provider Name | THEODORE JOSEPH GRADMAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 327 N SAN MATEO DR SUITE 3
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City | SAN MATEO
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State | CA
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Zip | 94401-2585
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Country | US
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Telephone | 650-340-0243
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Fax |
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Provider Business Mailing Address
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Address Line | 327 N SAN MATEO DR SUITE 3
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City | SAN MATEO
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State | CA
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Zip | 94401-2585
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Country | US
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Telephone | 650-340-0243
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PSY12044
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License Number State | CA
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