Provider Demographics
NPI:1033422845
Name:GRANDE, TODD LAWRENCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:LAWRENCE
Last Name:GRANDE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 FOULK RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3809
Mailing Address - Country:US
Mailing Address - Phone:302-655-3953
Mailing Address - Fax:302-655-1149
Practice Address - Street 1:405 FOULK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3809
Practice Address - Country:US
Practice Address - Phone:302-655-3953
Practice Address - Fax:302-655-1149
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health