Provider Demographics
NPI:1396969937
Name:GRAND, SUSAN L (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:GRAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:GRAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:764 WENDEL PL
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2161
Mailing Address - Country:US
Mailing Address - Phone:201-723-9424
Mailing Address - Fax:
Practice Address - Street 1:764 WENDEL PL
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2161
Practice Address - Country:US
Practice Address - Phone:201-692-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335100187100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV27231Medicare ID - Type Unspecified