Provider Demographics
NPI:1164542098
Name:GRANT, CATHLEEN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CATHLEEN
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 1:1559 BAY ST
Mailing Address - Street 2:APT 5
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-1051
Mailing Address - Country:US
Mailing Address - Phone:617-247-3939
Mailing Address - Fax:508-880-2072
Practice Address - Street 1:264 BEACON ST
Practice Address - Street 2:# 5
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-1236
Practice Address - Country:US
Practice Address - Phone:617-247-3939
Practice Address - Fax:508-880-2072
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030821041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1164542098OtherTUFTS HEALTH IPLAN
MAPO1988OtherBLUE CROSS BLUESHIELD