Provider Demographics
NPI:1568776912
Name:GRABOWY, MARISSA MILDRED (LEP)
Entity Type:Individual
Prefix:MISS
First Name:MARISSA
Middle Name:MILDRED
Last Name:GRABOWY
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3899 HAINES ST BLDG 8
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-6354
Mailing Address - Country:US
Mailing Address - Phone:858-775-2654
Mailing Address - Fax:858-246-6874
Practice Address - Street 1:3899 HAINES ST BLDG 8
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-6354
Practice Address - Country:US
Practice Address - Phone:858-775-2654
Practice Address - Fax:858-246-6874
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3128103K00000X, 103TB0200X, 103TC1900X, 103TM1800X, 103TS0200X
103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool