Provider Demographics
NPI:1093390908
Name:GRAMERCY THERAPY
Entity Type:Organization
Organization Name:GRAMERCY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-985-1022
Mailing Address - Street 1:300 S GRAMERCY PL APT 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4537
Mailing Address - Country:US
Mailing Address - Phone:310-985-1022
Mailing Address - Fax:
Practice Address - Street 1:300 S GRAMERCY PL APT 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-4537
Practice Address - Country:US
Practice Address - Phone:310-985-1022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629460720OtherNPI
CA4999941OtherMEDICAL
CA601066713OtherMAGELLAN