Provider Demographics
NPI:1952446353
Name:GRAD, LINDA RACHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:RACHELLE
Last Name:GRAD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 EAST 50TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-813-8084
Mailing Address - Fax:212-717-8150
Practice Address - Street 1:135 EAST 50TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-813-8084
Practice Address - Fax:212-717-8150
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY8732103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV40041Medicare ID - Type Unspecified