Provider Demographics
NPI:1033274790
Name:GRANT, LOUISE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-2039
Mailing Address - Country:US
Mailing Address - Phone:617-232-5737
Mailing Address - Fax:617-796-0188
Practice Address - Street 1:1093 BEACON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5695
Practice Address - Country:US
Practice Address - Phone:617-232-5737
Practice Address - Fax:617-796-0188
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1011231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA795262OtherTUFTS HEALTH PLAN
MAPO1154OtherBLUE CROSS
MA352685OtherMAGELLAN HEALTH
GRP20401Medicare ID - Type Unspecified