Provider Demographics
NPI:1538433180
Name:GRANILLO, OLGA ELENA (LCSW)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:ELENA
Last Name:GRANILLO
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 1:10151 ARROW RTE
Mailing Address - Street 2:UNIT 114
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4765
Mailing Address - Country:US
Mailing Address - Phone:760-861-7402
Mailing Address - Fax:
Practice Address - Street 1:10151 ARROW RTE
Practice Address - Street 2:UNIT 114
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4765
Practice Address - Country:US
Practice Address - Phone:760-861-7402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 241701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical