Provider Demographics
NPI:1245069459
Name:GRANT, NICOLE ADRIENNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ADRIENNE
Last Name:GRANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-2078
Mailing Address - Country:US
Mailing Address - Phone:781-854-2861
Mailing Address - Fax:
Practice Address - Street 1:370 MERRIMACK ST STE 240
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1789
Practice Address - Country:US
Practice Address - Phone:978-778-6196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2306311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical