Provider Demographics
NPI:1295032605
Name:GRANT, PENNY S (MA)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:S
Last Name:GRANT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 S PARK DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-5972
Mailing Address - Country:US
Mailing Address - Phone:802-264-5333
Mailing Address - Fax:802-264-5338
Practice Address - Street 1:245 S PARK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5972
Practice Address - Country:US
Practice Address - Phone:802-264-5333
Practice Address - Fax:802-264-5338
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0057747101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health