| Doctor Name: | DR. LAURA DIANE MAYNARD GRANT |
| NPI Number: | 1174936231 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | 05078 |
| Business Practice Address: | 7 Hadley St Suite 4 South Hadley, MA - 010751147 |
| Business Phone Number: | 7862697819 |
| Business Fax Number: | 4134377826 |
| Mailing Address: | 7 Hadley St, Suite 4 SOUTH HADLEY |
| State: | MA |
| Postal Code: | 010751147 |
| Phone Number: | 7862697819 |
| Fax Number: | 4134377826 |
| NPI Enumeration Date: | 06/06/2014 |
| NPI Last Update Date: | 06/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 05078 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |