Provider Demographics
NPI:1659824399
Name:GRADY, ERIC (PHD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:GRADY
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 1:1450 10TH ST STE 404
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2831
Mailing Address - Country:US
Mailing Address - Phone:716-572-3844
Mailing Address - Fax:
Practice Address - Street 1:1450 10TH ST STE 404
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2831
Practice Address - Country:US
Practice Address - Phone:716-572-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28039103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical