Healthcare Provider Details

I. General information

NPI: 1932200102
Provider Name (Legal Business Name): LAURA C DEGRANDIS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/22/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34970 DETROIT RD UNIT 210A
AVON OH
44011-2654
US

IV. Provider business mailing address

36459 S PARK DR
AVON OH
44011-3506
US

V. Phone/Fax

Practice location:
  • Phone: 480-385-8223
  • Fax:
Mailing address:
  • Phone: 480-385-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7325
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: