Provider Demographics
NPI:1215256797
Name:GRETHER, CRAIG B (PHD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:B
Last Name:GRETHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7271 SURFBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4022
Mailing Address - Country:US
Mailing Address - Phone:760-477-8585
Mailing Address - Fax:760-444-4786
Practice Address - Street 1:2173 SALK AVE
Practice Address - Street 2:STE 250
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7383
Practice Address - Country:US
Practice Address - Phone:760-477-8585
Practice Address - Fax:760-444-4786
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18336103G00000X, 103TC0700X, 103TF0000X, 103TR0400X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB230631Medicare PIN