Provider Demographics
NPI:1437565306
Name:MELISSA GRABAU PSYCHOLOGIST INC
Entity Type:Organization
Organization Name:MELISSA GRABAU PSYCHOLOGIST INC
Other - Org Name:MELISSA GRABAU, PHD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:GRABAU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-743-3870
Mailing Address - Street 1:711 33RD ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3816
Mailing Address - Country:US
Mailing Address - Phone:916-743-3870
Mailing Address - Fax:
Practice Address - Street 1:711 33RD ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3816
Practice Address - Country:US
Practice Address - Phone:916-743-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17025251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL170250Medicare PIN