Provider Demographics
NPI:1558606152
Name:GRASSETTI-KRUGLIKOV, SILIVIA ROSE (ED S)
Entity Type:Individual
Prefix:MRS
First Name:SILIVIA
Middle Name:ROSE
Last Name:GRASSETTI-KRUGLIKOV
Suffix:
Gender:F
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4740
Mailing Address - Country:US
Mailing Address - Phone:510-522-6722
Mailing Address - Fax:510-522-6722
Practice Address - Street 1:2850 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4740
Practice Address - Country:US
Practice Address - Phone:510-522-6722
Practice Address - Fax:510-522-6722
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110120706103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool