Provider Demographics
NPI:1255420378
Name:KONO, GRANT (LCSW)
Entity type:Individual
Prefix:MR
First Name:GRANT
Middle Name:
Last Name:KONO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35355 ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-3909
Mailing Address - Country:US
Mailing Address - Phone:909-266-1050
Mailing Address - Fax:909-266-1051
Practice Address - Street 1:35249 YUCAIPA BLVD STE B
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-4370
Practice Address - Country:US
Practice Address - Phone:909-266-1050
Practice Address - Fax:909-266-1595
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS198341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11331840OtherCAQH