Provider Demographics
NPI:1497894851
Name:GRANT, DENISE ROSITA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ROSITA
Last Name:GRANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 GUAVA ISLE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-1347
Mailing Address - Country:US
Mailing Address - Phone:954-467-7918
Mailing Address - Fax:
Practice Address - Street 1:105 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3239
Practice Address - Country:US
Practice Address - Phone:954-467-7918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 23501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical