Provider Demographics
NPI:1235906314
Name:GRANT, LISA L
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:L
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 KEYSTONE MANOR CT
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3951
Mailing Address - Country:US
Mailing Address - Phone:240-838-6835
Mailing Address - Fax:
Practice Address - Street 1:6804 KEYSTONE MANOR CT
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-3951
Practice Address - Country:US
Practice Address - Phone:240-838-6835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator