Provider Demographics
NPI:1336327253
Name:GRABOW, ROY (PHD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:GRABOW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E ST
Mailing Address - Street 2:SUITE 2- I
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4697
Mailing Address - Country:US
Mailing Address - Phone:530-756-1273
Mailing Address - Fax:
Practice Address - Street 1:105 E ST
Practice Address - Street 2:SUITE 2- I
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4697
Practice Address - Country:US
Practice Address - Phone:530-756-1273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9081103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist