Ethan M Grumbach, PH.D.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS19239 Issued in CA

Practice address

948 S Citrus Ave
Los Angeles, CA 90036-4929

Phone

(323) 933-3536

Fax

(323) 937-4070

NPI assigned

Mar 2, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2018 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104955681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "948 S CITRUS AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900364929",
            "telephone_number": "323-933-3536",
            "fax_number": "323-937-4070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "948 S CITRUS AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900364929",
            "telephone_number": "323-933-3536",
            "fax_number": "323-937-4070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUMBACH",
        "first_name": "ETHAN",
        "middle_name": "M",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS19239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vesna Grubic, RN, MSN, ANP, MPH
• Sierra Gruca, AMFT
• John Peter Gruen, M.D.
• Kevin Valon Gruenberg
• Jesse Grullon, DPT
• Becker Grumet
• Traci Grundland
• Margaret Judith Grundstein, MFT
• Dayna Grundy, MD
• Adam Gruner, M.D.

• Clinical Social Worker in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.