Provider Information for 1275692188
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SUSAN GRAYSEN PHD A PSYCHOLOGICAL CORPORATION
Organization Subpart: NO
NPI: 1275692188
Last Updated: 2021-07-02
Certification Date: 2021-07-02
Certification Date: 2021-07-02
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1275692188 | ||||||||
| Enumeration Date | 2006-12-06 | ||||||||
| NPI Type | NPI-2 Organization | ||||||||
| Status | Active | ||||||||
| Authorized Official Information | Name: Dr. SUSAN GRAYSEN PhD Title: President Phone: 3102777838 | ||||||||
| Mailing Address | 10573 W PICO BLVD # 242 LOS ANGELES, CA 90064-2333 United States Phone: 310-277-7838 | Fax:310-559-9802 | ||||||||
| Primary Practice Address | 9777 WILSHIRE BLVD STE 1007 BEVERLY HILLS, CA 90212-1901 United States Phone: 310-277-7838 | Fax:310-559-9802 | ||||||||
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