Provider Demographics
NPI:1265837306
Name:DEBBIE GRANICK LCSW RN LLC
Entity Type:Organization
Organization Name:DEBBIE GRANICK LCSW RN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-413-1391
Mailing Address - Street 1:8301 MARYLAND AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3660
Mailing Address - Country:US
Mailing Address - Phone:314-413-1391
Mailing Address - Fax:
Practice Address - Street 1:8301 MARYLAND AVE STE 330
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3660
Practice Address - Country:US
Practice Address - Phone:314-413-1391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100120641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty