Nickholas Grant, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

4836 Issued in CT

Practice address

6222 Avalon Dr W
Orange, CT 06477-3684

Phone

(203) 701-6047

NPI assigned

Sep 30, 2024

Sex

Male

Sole proprietor

No

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

Enrolled in CT

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.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Neuropsychology LLCGroup PAC ID 3375602931, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northeast Neuropsychology, LLC

  • Clinical Neuropsychologist
  • Cheshire, CT
  • NPI 1396991956
  Medicare reassignment Care Compare group NPD
• Advanced Telepsych PLLC

  • Psychiatry Physician
  • Middletown, CT
  • NPI 1508456377
  NPD

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

{
    "created_epoch": "1727654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1336967264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2389 MAIN ST STE 100",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060334617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6222 AVALON DR W",
            "city": "ORANGE",
            "state": "CT",
            "postal_code": "064773684",
            "telephone_number": "203-701-6047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "NICKHOLAS",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-30",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "4836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Del Carmen Gonzalez-Holmes
• Jazmin Gonzalez, SLP
• Gorgeous Smiles Dental Orange PLLC
• Attilio Vincent Granata, MD, MBA, FACP
• Alexis Diana Grant, PH.D.
• Erin Lenore Greenberg, OTD
• Philip N. Gross, LMFT
• Ayleen Gutierrez
• Elisha Hazel
• Nikime Headley

• Clinical Psychologist in Orange, CT
• Providers in Orange, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.