Provider Demographics
NPI:1093742983
Name:GRANT, PAMELA (MED)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 FRANKLIN ST., SUITE 204
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6021
Mailing Address - Country:US
Mailing Address - Phone:415-517-3525
Mailing Address - Fax:
Practice Address - Street 1:45 FRANKLIN ST, SUITE 204
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6021
Practice Address - Country:US
Practice Address - Phone:415-517-3525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40597106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist