Provider Demographics
NPI:1760705180
Name:GONZALEZ DE GRIESE, CLAUDIA JUDITH (BS, MS)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:JUDITH
Last Name:GONZALEZ DE GRIESE
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28152 RUBICON CT
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7012
Mailing Address - Country:US
Mailing Address - Phone:949-831-6070
Mailing Address - Fax:
Practice Address - Street 1:26137 LA PAZ RD
Practice Address - Street 2:STE. 230
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5319
Practice Address - Country:US
Practice Address - Phone:949-595-8610
Practice Address - Fax:949-595-0296
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81981101YM0800X
106H00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator