Individual
AUDREY GRUEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
CANYON CREST MENTAL HEALTH, 5225 CANYON CREST DRIVE #100, RIVERSIDE, CA 92507
(951) 248-4000
Mailing address
727 EUCLID ST, SANTA MONICA, CA 90402-2925
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
13328
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LCSW13328
—
CA
Enumeration date
11/10/2019
Last updated
11/10/2019
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