Provider Demographics
NPI:1437249984
Name:GROSSBARD, ROBERT LEE (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:GROSSBARD
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 1:928 6TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2764
Mailing Address - Country:US
Mailing Address - Phone:310-871-3997
Mailing Address - Fax:
Practice Address - Street 1:2444 WILSHIRE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5810
Practice Address - Country:US
Practice Address - Phone:310-281-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14993103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist