Provider Demographics
NPI:1518369743
Name:MARITE GRANDOVSKIS PHD
Entity Type:Organization
Organization Name:MARITE GRANDOVSKIS PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARITE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDOVSKIS
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:650-829-4911
Mailing Address - Street 1:1510 FASHION ISLAND BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1596
Mailing Address - Country:US
Mailing Address - Phone:650-829-4911
Mailing Address - Fax:
Practice Address - Street 1:1510 FASHION ISLAND BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-1596
Practice Address - Country:US
Practice Address - Phone:650-829-4911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16398103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty