Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 7267 | KY |
Y | 1041C0700X | Clinical Social Worker | 79092 | CA |
NPI | 1003272592 |
---|---|
Provider Name | Heather A Graviet |
First Address | San Francisco, CA 94107-1214 |
Second Address | San Francisco, CA 94107-1214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2016 |
Last Update Date | 12/10/2017 |