Provider Demographics
NPI:1447095195
Name:GROTKOWSKI REED, KAROLINA (PHD)
Entity type:Individual
Prefix:
First Name:KAROLINA
Middle Name:
Last Name:GROTKOWSKI REED
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3252 OVERLAND AVE APT 17
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3686
Mailing Address - Country:US
Mailing Address - Phone:773-909-1112
Mailing Address - Fax:
Practice Address - Street 1:3252 OVERLAND AVE APT 17
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3686
Practice Address - Country:US
Practice Address - Phone:773-909-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35044103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist