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General NPI Number Information
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NPI Number | 1477951275
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Entity Type | Organization
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Legal Business Name | GROSSBARD&BOURZAT CORP
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Dates
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Enumeration Date | 12/09/2014
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 618 ATHENS ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94112-3531
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Country | US
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Telephone | 415-705-0990
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Fax |
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Provider Business Mailing Address
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Address Line | 618 ATHENS ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94112-3531
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Country | US
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Telephone | 415-705-0990
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | AHARON GROSSBARD
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Credential | PHD
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Telephone | 415-705-0990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFT # 27213
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License Number State | CA
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