Provider Demographics
NPI:1619939592
Name:WALTER, GRANT J (LCSW C)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:J
Last Name:WALTER
Suffix:
Gender:M
Credentials:LCSW C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 ROCK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CONOWINGO
Mailing Address - State:MD
Mailing Address - Zip Code:21918-1352
Mailing Address - Country:US
Mailing Address - Phone:410-378-9696
Mailing Address - Fax:
Practice Address - Street 1:49 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CONOWINGO
Practice Address - State:MD
Practice Address - Zip Code:21918-1352
Practice Address - Country:US
Practice Address - Phone:410-378-9696
Practice Address - Fax:410-378-9922
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD059741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical