Provider Demographics
NPI:1144374703
Name:GRAGNANI, JOHN LOUIS (MS,MA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LOUIS
Last Name:GRAGNANI
Suffix:
Gender:M
Credentials:MS,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6171 WESTOVER DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3501 LONE TREE WAY
Practice Address - Street 2:#200
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6066
Practice Address - Country:US
Practice Address - Phone:925-427-8664
Practice Address - Fax:925-427-8645
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 34716106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist