Provider Demographics
NPI:1265828578
Name:JOEL GROSSBARD
Entity Type:Organization
Organization Name:JOEL GROSSBARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GROSSBARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-947-0152
Mailing Address - Street 1:333 NE 58TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2714
Mailing Address - Country:US
Mailing Address - Phone:206-947-0152
Mailing Address - Fax:
Practice Address - Street 1:333 NE 58TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2714
Practice Address - Country:US
Practice Address - Phone:206-947-0152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60309240261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)