Provider Demographics
NPI:1376233270
Name:GRANTO, MARK G (ADVANCED CASAC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:G
Last Name:GRANTO
Suffix:
Gender:M
Credentials:ADVANCED CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1285 MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1961
Mailing Address - Country:US
Mailing Address - Phone:716-961-6964
Mailing Address - Fax:
Practice Address - Street 1:1285 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1961
Practice Address - Country:US
Practice Address - Phone:716-961-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32174101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)