Basic Information
| Provider Information | |||||||||
| NPI: | 1396942660 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAUE | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 962 | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950610962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314544971 | ||||||||
| FaxNumber: | 8314544663 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 EMELINE AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950601976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314544170 | ||||||||
| FaxNumber: | 8314544663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 10/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW 12515 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X | LCSW 24717 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | ZZZ91892Z | 01 | CA | COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN# | OTHER | ZZZ92069Z | 01 | CA | COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN# | OTHER | ZZZ91891Z | 01 | CA | COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN# | OTHER |