Provider Demographics
NPI:1174608178
Name:GRANAT, JAY PAUL (PHD LMFT)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:PAUL
Last Name:GRANAT
Suffix:
Gender:M
Credentials:PHD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 MAIN STREET
Mailing Address - Street 2:SUITE 307
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661
Mailing Address - Country:US
Mailing Address - Phone:201-342-3663
Mailing Address - Fax:201-342-2258
Practice Address - Street 1:1060 MAIN STREET
Practice Address - Street 2:SUITE 307
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661
Practice Address - Country:US
Practice Address - Phone:201-342-3663
Practice Address - Fax:201-342-2258
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100078200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist