Basic Information
| Provider Information | |||||||||
| NPI: | 1972137404 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRINBERG | ||||||||
| FirstName: | AUSTIN | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4410 SEPULVEDA BLVD APT 402 | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914033958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104903245 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16111 PLUMMER ST # 11E | ||||||||
| Address2: | |||||||||
| City: | NORTH HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913432036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188917711 | ||||||||
| FaxNumber: | 8188959519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2020 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY30221 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.