MEDICARE: MS. BRIEL GRIVETTI

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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1811595903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRIEL GRIVETTI

Provider Business Mailing Address
First Line	:	1933 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-4501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1933 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-4501
Country	:	US
Telephone Number	:	206-525-5050
Fax Number	:

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

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	08/15/2024

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