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NPI Code Detail

MEDICARE: T GRANT PHD

MEDICARE: T GRANT PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist011779NY

General Provider Information

NPI Number : 1215211719
Entity Type Code : Organization
Provider Name (Legal Business Name) : T GRANT PHD
Provider Business Mailing Address
First Line : 257 MAIN ST
Second Line :
City : NEW PALTZ
State : NY
Zip : 12561-1610
Country : US
Telephone Number : 845-256-9528
Fax Number : 845-256-9528
Provider Business Practice Location Address
First Line : 257 MAIN ST
Second Line :
City : NEW PALTZ
State : NY
Zip : 12561-1610
Country : US
Telephone Number : 845-256-9528
Fax Number : 845-256-9528
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : DR. THOMAS H GRANT
Credential : PH.D.
Telephone Number : 845-256-9528
Provider Enumeration Date : 10/03/2011
Last Update Date : 10/03/2011

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