Provider Demographics
NPI:1942574330
Name:THOMAS GRACE PSY.D.
Entity Type:Organization
Organization Name:THOMAS GRACE PSY.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:201-207-2199
Mailing Address - Street 1:14-25 PLAZA RD
Mailing Address - Street 2:SUITE N-2-4
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3546
Mailing Address - Country:US
Mailing Address - Phone:201-207-2199
Mailing Address - Fax:
Practice Address - Street 1:14-25 PLAZA RD
Practice Address - Street 2:SUITE N-2-4
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3546
Practice Address - Country:US
Practice Address - Phone:201-207-2199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100487500261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)