Provider Demographics
NPI:1467043109
Name:CAFFIE-GRANT, KHADIJAH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KHADIJAH
Middle Name:
Last Name:CAFFIE-GRANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KHADIJAH
Other - Middle Name:
Other - Last Name:CAFFIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 BOULDER LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2926
Mailing Address - Country:US
Mailing Address - Phone:732-379-9962
Mailing Address - Fax:
Practice Address - Street 1:4 BOULDER LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2926
Practice Address - Country:US
Practice Address - Phone:732-379-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057086001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical