Active NPI
Matthew Grady, LMSW
- Professional Counselor
- East Hampton, NY
National Provider Identifier
1417309386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 72 049339
- Practice address
- 200 Pantigo PL
Suite I
East Hampton, NY 11937-5920 - Phone
- (631) 329-8430
- Fax
- (631) 329-8291
- NPI assigned
- Jul 5, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 72 049339 | NY | Primary |
Addresses
Primary practice location
200 Pantigo PL
Suite I
East Hampton, NY 11937-5920
Mailing address
200 Pantigo PL
Suite I
East Hampton, NY 11937-5920
Phone (631) 329-8430
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72 049339 | NY | MD | Professional Counselor |
| 049339 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467676800000",
"number": "1417309386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 PANTIGO PL",
"address_2": "SUITE I",
"city": "EAST HAMPTON",
"state": "NY",
"postal_code": "119375920",
"telephone_number": "631-329-8430",
"fax_number": "631-329-8291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 PANTIGO PL",
"address_2": "SUITE I",
"city": "EAST HAMPTON",
"state": "NY",
"postal_code": "119375920",
"telephone_number": "631-329-8430",
"fax_number": "631-329-8291"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRADY",
"first_name": "MATTHEW",
"name_prefix": "Mrs.",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-05",
"last_updated": "2016-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NY",
"license": "72 049339",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Hampton, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.