Basic Information
| Provider Information | |||||||||
| NPI: | 1437249984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROSSBARD | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23501 CINEMA DR | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913555428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612884800 | ||||||||
| FaxNumber: | 6612543094 | ||||||||
| Practice Location | |||||||||
| Address1: | 23501 CINEMA DR | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913555428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612884800 | ||||||||
| FaxNumber: | 6612543094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 05/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 14993 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.