Provider Demographics
NPI:1437565306
Name:MELISSA GRABAU PSYCHOLOGIST INC
Entity type:Organization
Organization Name:MELISSA GRABAU PSYCHOLOGIST INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:GRABAU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-743-3870
Mailing Address - Street 1:433 CABRILLO AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-0412
Mailing Address - Country:US
Mailing Address - Phone:916-743-3870
Mailing Address - Fax:
Practice Address - Street 1:433 CABRILLO AVE
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-0412
Practice Address - Country:US
Practice Address - Phone:916-743-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17025251S00000X
103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL170250Medicare PIN