Provider Demographics
NPI:1386813475
Name:GRAM, ROBERT LESLIE (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LESLIE
Last Name:GRAM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 KINNELON RD
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2335
Mailing Address - Country:US
Mailing Address - Phone:973-291-4096
Mailing Address - Fax:212-523-6494
Practice Address - Street 1:151 KINNELON RD
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2335
Practice Address - Country:US
Practice Address - Phone:973-291-4096
Practice Address - Fax:212-523-6494
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053423001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical