Provider Demographics
NPI:1164920872
Name:GRANESE, ANDREW P (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:P
Last Name:GRANESE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 BOSTON POST RD STE 4C
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3022
Mailing Address - Country:US
Mailing Address - Phone:978-622-2292
Mailing Address - Fax:978-288-0208
Practice Address - Street 1:323 BOSTON POST RD STE 4C
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3022
Practice Address - Country:US
Practice Address - Phone:978-622-2292
Practice Address - Fax:978-288-0208
Is Sole Proprietor?:No
Enumeration Date:2018-01-28
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN268088363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health