Active NPI
Susan L. Grand, PHD
- Clinical Psychologist
- Teaneck, NJ
National Provider Identifier
1396969937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 335100187100
- Practice address
- 764 Wendel PL
Teaneck, NJ 07666-2161 - Phone
- (201) 692-8310
- NPI assigned
- Apr 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 335100187100 | NY | Primary |
Addresses
Primary practice location
764 Wendel PL
Teaneck, NJ 07666-2161
Mailing address
764 Wendel PL
Teaneck, NJ 07666-2161
Phone (201) 723-9424
Other names 1
- Dr. Sue Grand
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 18, 2024 through Oct 18, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 335100187100 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727049600000",
"number": "1396969937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "764 WENDEL PL",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076662161",
"telephone_number": "201-723-9424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "764 WENDEL PL",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076662161",
"telephone_number": "201-692-8310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAND",
"first_name": "SUSAN",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-13",
"last_updated": "2024-09-23",
"certification_date": "2024-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "335100187100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SUE",
"last_name": "GRAND",
"prefix": "DR.",
"credential": "PHD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Teaneck, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.