Doctor Name: | MS. MARLA GRANDIS |
NPI Number: | 1114131463 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA LMHC |
License Number: | MH7600 |
Business Practice Address: | 1175 Ne 125 Street North Miami, FL - 33161 |
Business Phone Number: | 3058930048 |
Business Fax Number: | 3058930024 |
Mailing Address: | 1465 Ne 123 Street, 507 NORTH MIAMI |
State: | FL |
Postal Code: | 331616038 |
Phone Number: | 3059811521 |
Fax Number: | |
NPI Enumeration Date: | 05/09/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH7600 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |