Provider Demographics
NPI:1437377785
Name:GRANJEAN, ROGER (LCSW)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:GRANJEAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 S GRAND HWY
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3200
Mailing Address - Country:US
Mailing Address - Phone:646-208-2197
Mailing Address - Fax:
Practice Address - Street 1:711 BALLARD ST
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5441
Practice Address - Country:US
Practice Address - Phone:407-339-7451
Practice Address - Fax:407-862-2737
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSW6651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical