Healthcare Provider Details

I. General information

NPI: 1063407054
Provider Name (Legal Business Name): ANN D GRACER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6724 165TH ST
FRESH MEADOWS NY
11365-3204
US

IV. Provider business mailing address

6724 165TH ST
FRESH MEADOWS NY
11365-3204
US

V. Phone/Fax

Practice location:
  • Phone: 718-463-4640
  • Fax: 718-463-4655
Mailing address:
  • Phone: 718-463-4640
  • Fax: 718-463-4655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number01778
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number01778
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01778
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number01778
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number01778
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01778
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number01778
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: