Provider Demographics
NPI:1598075582
Name:GRENET, JULIE ELISE (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ELISE
Last Name:GRENET
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 FREDERICK DOUGLASS BLVD APT 7B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5085
Mailing Address - Country:US
Mailing Address - Phone:646-831-1352
Mailing Address - Fax:
Practice Address - Street 1:2300 FREDERICK DOUGLASS BLVD APT 7B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5085
Practice Address - Country:US
Practice Address - Phone:646-831-1352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000932-1102L00000X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst