Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 29553 | CA |
Y | 103G00000X | Clinical Psychologist | 29553 | CA |
Y | 103TC0700X | Clinical Psychologist | 29553 | CA |
N | 103TF0000X | Family Psychologist | 29553 | CA |
NPI | 1184131245 |
---|---|
Provider Name | Dr. Nina Grayson |
First Address | Sausalito, CA 94965-2899 |
Second Address | Sausalito, CA 94965-2899 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2018 |
Last Update Date | 10/01/2018 |