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General NPI Number Information
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NPI Number | 1861375180
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Entity Type | Individual
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Provider Name | TYLER GRACE AUSTIN
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Gender | Female
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Dates
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Enumeration Date | 07/26/2025
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Last Update Date | 07/26/2025
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Provider Practice Location Address
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Address Line | 25 COMMERCE DR STE 210
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City | CRANFORD
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State | NJ
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Zip | 07016-3621
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Country | US
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Telephone | 908-905-3444
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Fax |
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Provider Business Mailing Address
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Address Line | 217 RUTHERFORD PL
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City | NORTH ARLINGTON
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State | NJ
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Zip | 07031-6006
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Country | US
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Telephone | 201-281-6656
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL07319200
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License Number State | NJ
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