Grey Space Therapy, LCSW Professional Corporation

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

GREY SPACE THERAPY, LCSW PROFESSIONAL CORPORATION

Practice address

5055 Canyon Crest Dr Ste 216
Riverside, CA 92507-6015

Phone

(714) 749-5554

NPI assigned

Jan 16, 2023

Organization subpart

No

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

Authorized official

Name

Fabiola Pacheco, LCSWNPI 1225690233

Title

Founder

Phone

(714) 749-5554

Specialties & licenses 4

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fabiola Pacheco, LCSW

  • Clinical Social Worker
  • Riverside, CA
  • NPI 1225690233
  NPD Authorized official

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

{
    "created_epoch": "1673827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673827200000",
    "number": "1174238190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5744 CREST AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925038634",
            "telephone_number": "714-749-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5055 CANYON CREST DR STE 216",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925076015",
            "telephone_number": "714-749-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREY SPACE THERAPY, LCSW PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-16",
        "last_updated": "2023-01-16",
        "certification_date": "2023-01-14",
        "status": "A",
        "authorized_official_last_name": "PACHECO",
        "authorized_official_first_name": "FABIOLA",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "714-749-5554",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaclyn M Grentzer, MD, MSCI
• Ashley Diane Grether, BA SPLA
• Paul Grewal, DDS
• Prabhjot Kaur Grewal, MD
• Ravneet Kaur Grewal
• Greystone Behavioral Health Nursing Inc
• Lisa Gribble, RDN
• Michael Gribble, MD
• Patricia Ann Griffin-Gordon
• Aaron Lewis Griffin, DC

• Clinical Social Worker in Riverside, CA
• Providers in Riverside, 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 Jan 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.