Provider Demographics
NPI:1265805972
Name:GIANGRASSO, KEVIN EDWARD ARORA (PSYD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:EDWARD ARORA
Last Name:GIANGRASSO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:EDWARD
Other - Last Name:GIANGRASSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:480 GORDON RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4620
Mailing Address - Country:US
Mailing Address - Phone:201-632-1548
Mailing Address - Fax:
Practice Address - Street 1:44 GODWIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1959
Practice Address - Country:US
Practice Address - Phone:201-632-1548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP99994103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical