Provider Demographics
NPI:1366213027
Name:FAITH AND GRACE PSYCHOTHEREAPY
Entity type:Organization
Organization Name:FAITH AND GRACE PSYCHOTHEREAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/APN
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-266-8267
Mailing Address - Street 1:260 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2509
Mailing Address - Country:US
Mailing Address - Phone:862-266-8267
Mailing Address - Fax:
Practice Address - Street 1:87 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:NJ
Practice Address - Zip Code:07934
Practice Address - Country:US
Practice Address - Phone:862-266-8267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty