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General NPI Number Information
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NPI Number | 1518369743
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Entity Type | Organization
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Legal Business Name | MARITE GRANDOVSKIS PHD
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 1510 FASHION ISLAND BLVD SUITE 110
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City | SAN MATEO
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State | CA
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Zip | 94404-1596
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Country | US
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Telephone | 650-829-4911
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 FASHION ISLAND BLVD SUITE 110
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City | SAN MATEO
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State | CA
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Zip | 94404-1596
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Country | US
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Telephone | 650-829-4911
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. MARITE GRANDOVSKIS
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Credential | PH. D.
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Telephone | 650-829-4911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY16398
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License Number State | CA
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