Provider Demographics
NPI:1609067404
Name:GRADO, REBECCA (MFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GRADO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 MUNRAS PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3040
Mailing Address - Country:US
Mailing Address - Phone:925-829-6745
Mailing Address - Fax:
Practice Address - Street 1:3212 MUNRAS PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3040
Practice Address - Country:US
Practice Address - Phone:925-829-6745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23947106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist