Danielle Teresa Graddick, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

35SI00642800 Issued in NJ

Practice address

408 Bloomfield Ave Ste a-1
Montclair, NJ 07042-3573

Phone

(862) 217-6029

NPI assigned

Feb 12, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1613088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663372800000",
    "number": "1396338166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 BLOOMFIELD AVE STE A-1",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423573",
            "telephone_number": "862-217-6029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 BLOOMFIELD AVE STE A-1",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423573",
            "telephone_number": "862-217-6029"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "513 W Mount Pleasant Ave Ste 105",
            "address_purpose": "LOCATION",
            "city": "Livingston",
            "state": "NJ",
            "postal_code": "070391721",
            "country_code": "US",
            "telephone_number": "973-994-7177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRADDICK",
        "first_name": "DANIELLE",
        "middle_name": "TERESA",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-12",
        "last_updated": "2022-09-17",
        "certification_date": "2022-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "024156",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35SI00642800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Montclair, NJ
• Providers in Montclair, NJ by specialty
• Clinical Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.