Provider Demographics
NPI:1972137404
Name:GRINBERG, AUSTIN (PHD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:GRINBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21534 DEVONSHIRE ST STE I
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2992
Mailing Address - Country:US
Mailing Address - Phone:818-208-0611
Mailing Address - Fax:
Practice Address - Street 1:21534 DEVONSHIRE ST STE I
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2992
Practice Address - Country:US
Practice Address - Phone:818-208-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30221103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical