Active NPI
Jendayo Grady, PHD
- Mental Health Counselor
- College Park, MD
National Provider Identifier
1790907327
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- PSY1000361
- Practice address
- 7307 Baltimore Ave Ste 214
College Park, MD 20740-3231 - Phone
- (240) 515-5353
- NPI assigned
- May 3, 2007
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | PSY1000361 | DC | Primary |
| Clinical Psychologist | 103TC0700X | 04212 | MD | |
| Clinical Psychologist | 103TC0700X | PSY1000361 | DC |
Addresses
Primary practice location
7307 Baltimore Ave Ste 214
College Park, MD 20740-3231
Mailing address
PO Box 3740
Silver Spring, MD 20918-3740
Phone (240) 515-5353
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 |
|---|---|---|---|
| PSY1000361 | DC | MD | Mental Health Counselor |
| 04212 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184803200000",
"number": "1790907327",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3740",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209183740",
"telephone_number": "240-515-5353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7307 BALTIMORE AVE STE 214",
"city": "COLLEGE PARK",
"state": "MD",
"postal_code": "207403231",
"telephone_number": "240-515-5353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRADY",
"first_name": "JENDAYO",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-03",
"last_updated": "2007-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "DC",
"license": "PSY1000361",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "04212",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "DC",
"license": "PSY1000361",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in College Park, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.