Provider Demographics
NPI:1033124722
Name:GRAU, NANCY AEREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:AEREN
Last Name:GRAU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 SOLANO DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3383
Mailing Address - Country:US
Mailing Address - Phone:505-385-0225
Mailing Address - Fax:505-255-3704
Practice Address - Street 1:404 SAN MATEO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5547
Practice Address - Country:US
Practice Address - Phone:505-385-0225
Practice Address - Fax:505-255-3704
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM812103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10070541Medicaid