Provider Demographics
NPI:1861375180
Name:AUSTIN, TYLER GRACE
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:GRACE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 RUTHERFORD PL
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-6006
Mailing Address - Country:US
Mailing Address - Phone:201-281-6656
Mailing Address - Fax:
Practice Address - Street 1:25 COMMERCE DR STE 210
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3621
Practice Address - Country:US
Practice Address - Phone:908-905-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07319200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker