Provider Demographics
NPI:1407653041
Name:GRAULAU, MAYDA T (PHD)
Entity type:Individual
Prefix:DR
First Name:MAYDA
Middle Name:T
Last Name:GRAULAU
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 AVE JOBOS APT 714
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-5507
Mailing Address - Country:US
Mailing Address - Phone:787-243-6908
Mailing Address - Fax:
Practice Address - Street 1:700 AVE JOBOS APT 714
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-5507
Practice Address - Country:US
Practice Address - Phone:787-243-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7805103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty