Doctor Name: | MR. JAMES E GRANT |
NPI Number: | 1063728608 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CASAC |
License Number: | 17564 |
Business Practice Address: | 40 Main St Westhampton Beach, NY - 119782673 |
Business Phone Number: | 6312881955 |
Business Fax Number: | |
Mailing Address: | 19 Evy Ct, SAYVILLE |
State: | NY |
Postal Code: | 11782 |
Phone Number: | 6315123642 |
Fax Number: | |
NPI Enumeration Date: | 08/20/2010 |
NPI Last Update Date: | 08/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 17564 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |