Provider Demographics
NPI:1457075301
Name:JOSEPH, GRACE F (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:F
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 TITUS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-1738
Mailing Address - Country:US
Mailing Address - Phone:585-773-1111
Mailing Address - Fax:
Practice Address - Street 1:755 JEFFERSON RD STE 4A
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-3270
Practice Address - Country:US
Practice Address - Phone:585-773-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP118203103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP118203OtherLIMITED PERMIT