Provider Demographics
NPI:1568572329
Name:GRAUBART, STANLEY EDWARD (MA MFT)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:EDWARD
Last Name:GRAUBART
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 WALNUT STREET
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070
Mailing Address - Country:US
Mailing Address - Phone:650-595-2698
Mailing Address - Fax:650-595-5976
Practice Address - Street 1:626 WALNUT STREET
Practice Address - Street 2:SUITE 213
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070
Practice Address - Country:US
Practice Address - Phone:650-595-2698
Practice Address - Fax:650-595-5976
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24244106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22223195212Medicare UPIN