Provider Demographics
NPI:1023351657
Name:MCGRUDER, JAMES A (CRC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:MCGRUDER
Suffix:
Gender:M
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-5622
Mailing Address - Country:US
Mailing Address - Phone:856-981-3126
Mailing Address - Fax:
Practice Address - Street 1:360 CHERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-5622
Practice Address - Country:US
Practice Address - Phone:856-981-3126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TR0400X
NJ00016627171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation