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General NPI Number Information
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NPI Number | 1932566098
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Entity Type | Individual
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Provider Name | PATRICIA GRADY PHD
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Gender | Female
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 8116 HEARTHSTONE PL
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City | ANTELOPE
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State | CA
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Zip | 95843-4620
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Country | US
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Telephone | 916-725-8716
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Fax |
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Provider Business Mailing Address
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Address Line | 8116 HEARTHSTONE PL
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City | ANTELOPE
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State | CA
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Zip | 95843-4620
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Country | US
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Telephone | 916-725-8716
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 27151
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License Number State | CA
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