Active NPI
Kamau I Imarogbe Grantham, PH. D.
- Clinical Psychologist
- Jamaica, NY
National Provider Identifier
1285709295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 68 016333
- Practice address
- 11402 Guy R Brewer Blvd
Suite 216
Jamaica, NY 11434-1234 - Phone
- (718) 883-6650
- Fax
- (718) 883-6669
- NPI assigned
- Nov 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 68 016333 | NY | Primary |
Addresses
Primary practice location
11402 Guy R Brewer Blvd
Suite 216
Jamaica, NY 11434-1234
Mailing address
11402 Guy R Brewer Blvd
Suite 216
Jamaica, NY 11434-1234
Phone (718) 883-6650
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00246075 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 68 016333 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277164800000",
"number": "1285709295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11402 GUY R BREWER BLVD",
"address_2": "SUITE 216",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114341234",
"telephone_number": "718-883-6650",
"fax_number": "718-883-6669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11402 GUY R BREWER BLVD",
"address_2": "SUITE 216",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114341234",
"telephone_number": "718-883-6650",
"fax_number": "718-883-6669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMAROGBE GRANTHAM",
"first_name": "KAMAU",
"middle_name": "I",
"name_prefix": "Dr.",
"credential": "PH. D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-22",
"last_updated": "2010-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "68 016333",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00246075",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamaica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.