Provider Demographics
NPI:1144650326
Name:GRANT, LAURIE
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:GRANT
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 1:775 E FALMOUTH HWY
Mailing Address - Street 2:#275
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-6191
Mailing Address - Country:US
Mailing Address - Phone:800-735-8951
Mailing Address - Fax:866-437-5208
Practice Address - Street 1:10 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-6122
Practice Address - Country:US
Practice Address - Phone:800-735-8951
Practice Address - Fax:866-437-5208
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1178521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical