Basic Information
| Provider Information | |||||||||
| NPI: | 1194490615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROWNEY | ||||||||
| FirstName: | STEVEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2308 P ST APT 17 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958166221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502558421 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4441 AUBURN BLVD STE E | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958414139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164735764 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2021 | ||||||||
| LastUpdateDate: | 08/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 98892 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.