Provider Demographics
NPI:1992974828
Name:GRADY, PAULINE
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:GRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PAULINE
Other - Middle Name:R
Other - Last Name:GRADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BACHELOR OF SCIENCE
Mailing Address - Street 1:333 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088
Mailing Address - Country:US
Mailing Address - Phone:484-623-4261
Mailing Address - Fax:
Practice Address - Street 1:492 ROUTE 57 WEST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882
Practice Address - Country:US
Practice Address - Phone:908-689-1000
Practice Address - Fax:908-689-4529
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor