Provider Demographics
NPI:1982101457
Name:GRACE, CYNTHIA LOUISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:GRACE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2079 HENRY HART DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5267
Mailing Address - Country:US
Mailing Address - Phone:925-381-8367
Mailing Address - Fax:
Practice Address - Street 1:2079 HENRY HART DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5267
Practice Address - Country:US
Practice Address - Phone:925-933-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29972103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical