Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 009344-1 | NY |
N | 103T00000X | Psychologist | 009344-1 | NY |
N | 103TA0700X | Adult Development & Aging Psychologist | 009344-1 | NY |
N | 103G00000X | Clinical Psychologist | 009344-1 | NY |
N | 103TC0700X | Clinical Psychologist | 009344-1 | NY |
N | 103TH0100X | Health Service | 009344-1 | NY |
N | 103TM1800X | Intellectual & Developmental Disabilities | 009344-1 | NY |
N | 103TP2701X | Group Psychotherapist | 009344-1 | NY |
N | 103TR0400X | Rehabilitation Psychologist | 009344-1 | NY |
NPI | 1053349431 |
---|---|
Provider Name | Dr. Julia Elizabeth Grant |
First Address | New Hartford, NY 13413-9733 |
Second Address | New Hartford, NY 13413-9733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01178761 | (05) | NY |
133881 | VALUE OPTIONS PROVIDER NU (01) | NY |
R55878 | (02) | NY |