Provider Demographics
NPI:1437236247
Name:GRANT, THOMAS H (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:GRANT
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 1:257 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1610
Mailing Address - Country:US
Mailing Address - Phone:845-256-9528
Mailing Address - Fax:845-256-9528
Practice Address - Street 1:257 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1610
Practice Address - Country:US
Practice Address - Phone:845-256-9528
Practice Address - Fax:845-256-9528
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011779103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01891625Medicaid
NYR52529Medicare UPIN
NYV3C202Medicare ID - Type Unspecified