MEDICARE: MS. CARO S. GROSVENOR MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	20804	CA

General Provider Information

NPI Number	:	1013115419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARO S. GROSVENOR MFT

Provider Business Mailing Address
First Line	:	4 FRANCISCAN WAY
Second Line	:
City	:	KENSINGTON
State	:	CA
Zip	:	94707-1113
Country	:	US
Telephone Number	:	510-734-6559
Fax Number	:	510-526-4092

Provider Business Practice Location Address
First Line	:	2526 WEBSTER ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2550
Country	:	US
Telephone Number	:	510-734-6559
Fax Number	:	510-526-4092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	07/08/2007

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