Provider Demographics
NPI:1902349731
Name:ADRIANNE AHERN-GRUNDLAND,PH.D.PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:ADRIANNE AHERN-GRUNDLAND,PH.D.PSYCHOLOGY CORPORATION
Other - Org Name:ADRIANNE AHERN-GRUNDLAND, PH.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:AHERN-GRUNDLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-764-2422
Mailing Address - Street 1:11622 EL CAMINO REAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2049
Mailing Address - Country:US
Mailing Address - Phone:858-764-2422
Mailing Address - Fax:
Practice Address - Street 1:11622 EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2049
Practice Address - Country:US
Practice Address - Phone:858-764-2422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14473103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty