Provider Demographics
NPI:1457341075
Name:GRANDA-GILBERT, DENISE (PHD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:GRANDA-GILBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 STATION SQUARE
Mailing Address - Street 2:OFFICE ON STREET LEVEL
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5234
Mailing Address - Country:US
Mailing Address - Phone:718-768-8081
Mailing Address - Fax:718-268-2281
Practice Address - Street 1:6 STATION SQUARE
Practice Address - Street 2:OFFICE ON STREET LEVEL
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5234
Practice Address - Country:US
Practice Address - Phone:718-768-8081
Practice Address - Fax:718-268-2281
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7280103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01527191Medicaid
NY01527191Medicaid