Provider Demographics
NPI:1013229079
Name:DR DENISE GRANDA-GILBERT CLINICAL PSYCHOLOGIST, P.C.
Entity Type:Organization
Organization Name:DR DENISE GRANDA-GILBERT CLINICAL PSYCHOLOGIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDA-GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-268-8081
Mailing Address - Street 1:6 STATION SQUARE
Mailing Address - Street 2:OFFICE ON STREET LEVEL
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5234
Mailing Address - Country:US
Mailing Address - Phone:718-268-8081
Mailing Address - Fax:718-268-2281
Practice Address - Street 1:6 STATION SQUARE
Practice Address - Street 2:OFFICE ON STREET LEVEL
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5234
Practice Address - Country:US
Practice Address - Phone:718-268-8081
Practice Address - Fax:718-268-2281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7280103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01527191Medicaid
NYGHI32710Medicare UPIN