Basic Information
| Provider Information | |||||||||
| NPI: | 1255766861 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIRIAKOS | ||||||||
| FirstName: | GRACE | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2728 DURANT AVE | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947041725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108419230 | ||||||||
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| Practice Location | |||||||||
| Address1: | 604 EMPIRE ST FL 1 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945335527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078623872 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2013 | ||||||||
| LastUpdateDate: | 09/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225C00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.