Provider Demographics
NPI:1265272405
Name:RYAN GRADY, LICENSED CLINICAL SOCIAL WORKER INC.
Entity type:Organization
Organization Name:RYAN GRADY, LICENSED CLINICAL SOCIAL WORKER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:213-927-5451
Mailing Address - Street 1:3217 ETTRICK ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2503
Mailing Address - Country:US
Mailing Address - Phone:213-927-5451
Mailing Address - Fax:
Practice Address - Street 1:3217 ETTRICK ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-2503
Practice Address - Country:US
Practice Address - Phone:213-927-5451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty