Provider Demographics
NPI:1477951275
Name:GROSSBARD&BOURZAT CORP
Entity Type:Organization
Organization Name:GROSSBARD&BOURZAT CORP
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSBARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-705-0990
Mailing Address - Street 1:618 ATHENS ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3531
Mailing Address - Country:US
Mailing Address - Phone:415-705-0990
Mailing Address - Fax:
Practice Address - Street 1:618 ATHENS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-3531
Practice Address - Country:US
Practice Address - Phone:415-705-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT # 27213251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health