Provider Demographics
NPI:1265427744
Name:CROYLE, GRANT WALDO (PHD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:WALDO
Last Name:CROYLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 SCALP AVE
Mailing Address - Street 2:STE 209
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3374
Mailing Address - Country:US
Mailing Address - Phone:814-266-3196
Mailing Address - Fax:814-266-6296
Practice Address - Street 1:1450 SCALP AVE
Practice Address - Street 2:STE 209
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3374
Practice Address - Country:US
Practice Address - Phone:814-266-3196
Practice Address - Fax:814-266-6296
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003270L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA443018Medicare ID - Type Unspecified
604488Medicare ID - Type UnspecifiedGROUP