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General NPI Number Information
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NPI Number | 1700937885
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Entity Type | Individual
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Provider Name | KATHLEEN GRIMARD LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 2727 CAMINO DEL RIO S SUITE 150
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City | SAN DIEGO
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State | CA
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Zip | 92108-3750
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Country | US
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Telephone | 619-733-8337
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Fax | 619-546-6030
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Provider Business Mailing Address
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Address Line | 5402 WARING RD
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City | SAN DIEGO
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State | CA
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Zip | 92120-1850
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Country | US
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Telephone | 619-733-8337
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Fax | 619-546-6030
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS18986
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License Number State | CA
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