Provider Demographics
NPI:1508869256
Name:GRANT, JOHN H (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:H
Last Name:GRANT
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 WALL ST.
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3849
Mailing Address - Country:US
Mailing Address - Phone:845-339-5572
Mailing Address - Fax:845-339-5572
Practice Address - Street 1:291 WALL ST.
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3849
Practice Address - Country:US
Practice Address - Phone:845-339-5572
Practice Address - Fax:845-339-5572
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002451-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N37731Medicare PIN