Grady Dale Jr., EDD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

01611 Issued in MD

Practice address

4119 Falls Rd Ste E
Baltimore, MD 21211-1642

Phone

(410) 963-0085

Fax

(410) 366-1668

NPI assigned

Mar 6, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2013 through Jul 1, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1144350653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4419 FALLS ROAD",
            "address_2": "FALLS LANE MEDICAL CENTER STE E",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212111226",
            "telephone_number": "410-578-0336",
            "fax_number": "410-361-0651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4119 FALLS RD STE E",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212111642",
            "telephone_number": "410-963-0085",
            "fax_number": "410-366-1668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALE",
        "first_name": "GRADY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "EDD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "01611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Dait
• Marco Dal Molin, M.D.
• Sonia P Dalal, MD
• Caroline Gernell Dale, M.D.
• Deborah Lynn Dale, PT
• Jaony Dale
• Leslie Dalencour
• Nicholas Michael Dalesio, M.D.
• Dalewood Homes
• Pauline Maria Daley Richards, M.D.

• Clinical Psychologist in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Clinical Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.