Provider Demographics
NPI:1457014649
Name:GRANT, BRUCE ORMOND (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ORMOND
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 1:9720 AVENUE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5328
Mailing Address - Country:US
Mailing Address - Phone:347-656-5002
Mailing Address - Fax:
Practice Address - Street 1:9720 AVENUE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5328
Practice Address - Country:US
Practice Address - Phone:347-656-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional