Healthcare Provider Details

I. General information

NPI: 1316334782
Provider Name (Legal Business Name): JEFFREY S. GRAND, PSYD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 ROOSEVELT BLVD STE 206
PHILADELPHIA PA
19152-2081
US

IV. Provider business mailing address

8400 ROOSEVELT BLVD STE 206
PHILADELPHIA PA
19152-2081
US

V. Phone/Fax

Practice location:
  • Phone: 215-333-7562
  • Fax: 215-333-7563
Mailing address:
  • Phone: 215-333-7562
  • Fax: 215-333-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY GRAND
Title or Position: PARTNER
Credential: PSYD
Phone: 215-333-7562