Provider Demographics
NPI:1013115419
Name:GROSVENOR, CARO S (MFT)
Entity type:Individual
Prefix:MS
First Name:CARO
Middle Name:S
Last Name:GROSVENOR
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 1:4 FRANCISCAN WAY
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:94707-1113
Mailing Address - Country:US
Mailing Address - Phone:510-734-6559
Mailing Address - Fax:510-526-4092
Practice Address - Street 1:2526 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2550
Practice Address - Country:US
Practice Address - Phone:510-734-6559
Practice Address - Fax:510-526-4092
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist