Provider Demographics
NPI:1114131463
Name:GRANDIS, MARLA (MA LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:
Last Name:GRANDIS
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 NE 123 STREET
Mailing Address - Street 2:507
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6038
Mailing Address - Country:US
Mailing Address - Phone:305-981-1521
Mailing Address - Fax:
Practice Address - Street 1:1175 NE 125 STREET
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161
Practice Address - Country:US
Practice Address - Phone:305-893-0048
Practice Address - Fax:305-893-0024
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health