Provider Demographics
NPI:1447766993
Name:ANDREA GRANATH LLC
Entity Type:Organization
Organization Name:ANDREA GRANATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANATH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-848-6399
Mailing Address - Street 1:35 BOSTON STREET
Mailing Address - Street 2:LOWER LEVEL, LEFT SIDE
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 BOSTON STREET
Practice Address - Street 2:LOWER LEVEL, LEFT SIDE
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437
Practice Address - Country:US
Practice Address - Phone:631-848-6399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1386971851Medicaid