Provider Demographics
NPI:1316969652
Name:STRINE, GRANT NELSON (PSYD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:NELSON
Last Name:STRINE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3505
Mailing Address - Country:US
Mailing Address - Phone:610-329-0060
Mailing Address - Fax:
Practice Address - Street 1:101 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5315
Practice Address - Country:US
Practice Address - Phone:610-544-2110
Practice Address - Fax:610-604-9510
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical