Provider Demographics
NPI:1053349431
Name:GRANT, JULIA ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:ELIZABETH
Last Name:GRANT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3985 ONEIDA ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-9733
Mailing Address - Country:US
Mailing Address - Phone:315-736-7104
Mailing Address - Fax:315-797-3401
Practice Address - Street 1:3985 ONEIDA ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-9733
Practice Address - Country:US
Practice Address - Phone:315-736-7104
Practice Address - Fax:315-797-3401
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009344-1103TA0700X, 103TC0700X, 103TH0100X, 103TM1800X, 103T00000X, 103TP2701X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01178761Medicaid
NY133881OtherVALUE OPTIONS PROVIDER NU
NY133881OtherVALUE OPTIONS PROVIDER NU
NYR55878Medicare UPIN