Provider Demographics
NPI:1770861460
Name:GRIGORIAN, NYIRI (LCSW, PHD)
Entity Type:Individual
Prefix:PROF
First Name:NYIRI
Middle Name:
Last Name:GRIGORIAN
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1802
Mailing Address - Country:US
Mailing Address - Phone:201-694-2386
Mailing Address - Fax:
Practice Address - Street 1:163 ENGLE ST
Practice Address - Street 2:BUILDING 1
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2535
Practice Address - Country:US
Practice Address - Phone:201-568-4794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ444SC052117001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical