Provider Demographics
NPI:1982879516
Name:GRACE, JOEL E (PHD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:E
Last Name:GRACE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OLCOTT RD N
Mailing Address - Street 2:
Mailing Address - City:BIG FLATS
Mailing Address - State:NY
Mailing Address - Zip Code:14814-7901
Mailing Address - Country:US
Mailing Address - Phone:607-562-7304
Mailing Address - Fax:607-562-7304
Practice Address - Street 1:3 OLCOTT RD N
Practice Address - Street 2:
Practice Address - City:BIG FLATS
Practice Address - State:NY
Practice Address - Zip Code:14814-7901
Practice Address - Country:US
Practice Address - Phone:607-562-7304
Practice Address - Fax:607-562-7304
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7579103T00000X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103T00000XBehavioral Health & Social Service ProvidersPsychologist