=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649372301
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH K. GRINBERG MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2006
-----------------------------------------------------
Last Update Date | 01/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 N SAN ANTONIO RD SUITE 206
-----------------------------------------------------
City | LOS ALTOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94022-1373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-323-2227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1254 MIDDLEFIELD RD
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94301-3346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-321-2272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 10119
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------