Provider Demographics
NPI:1578996872
Name:GRATTAN, GIL J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GIL
Middle Name:J
Last Name:GRATTAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 S MARENGO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3113
Mailing Address - Country:US
Mailing Address - Phone:818-317-8866
Mailing Address - Fax:
Practice Address - Street 1:446 S MARENGO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3113
Practice Address - Country:US
Practice Address - Phone:818-317-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-10
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25878103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical