Provider Demographics
NPI:1609356450
Name:INNOVATE PSYCHOLOGY INC
Entity Type:Organization
Organization Name:INNOVATE PSYCHOLOGY INC
Other - Org Name:SONIA GREAVEN, PH.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERTEN-GREAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-797-4653
Mailing Address - Street 1:23632 CALABASAS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1737
Mailing Address - Country:US
Mailing Address - Phone:818-797-4653
Mailing Address - Fax:747-226-0291
Practice Address - Street 1:23632 CALABASAS RD STE 202
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1737
Practice Address - Country:US
Practice Address - Phone:818-797-4653
Practice Address - Fax:747-226-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20962103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty