Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1255766861 |
---|---|
Provider Name | Grace Kiriakos |
First Address | Berkeley, CA 94704-1725 |
Second Address | Fairfield, CA 94533-5527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2013 |
Last Update Date | 15/09/2019 |