MEDICARE: DANA RICHARDSON GRIP PHD

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	103TC0700X	Clinical Psychologist	024088	NY
2	103TC0700X	Clinical Psychologist	PSY29379	CA

General Provider Information

NPI Number	:	1548693732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA RICHARDSON GRIP PHD

Provider Business Mailing Address
First Line	:	PO BOX 752
Second Line	:
City	:	VERDUGO CITY
State	:	CA
Zip	:	91046-0752
Country	:	US
Telephone Number	:	818-927-1743
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 FOOTHILL BLVD
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-3506
Country	:	US
Telephone Number	:	818-927-1743
Fax Number	:

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

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	02/03/2023

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