Individual
CLARK STANFORD GROVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1902 WEBSTER ST, SAN FRANCISCO, CA 94115-5800
(415) 923-6760
(415) 507-0306
Mailing address
1902 WEBSTER ST, SAN FRANCISCO, CA 94115-5800
(415) 923-6760
(415) 507-0306
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY13469
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PL134690
BLUE SHIELD
CA
Enumeration date
01/12/2007
Last updated
07/08/2007
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