Provider Demographics
NPI:1518095751
Name:DAVID L. GRANOFF, PSY.D., INC.
Entity Type:Organization
Organization Name:DAVID L. GRANOFF, PSY.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:216-752-5346
Mailing Address - Street 1:21403 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5322
Mailing Address - Country:US
Mailing Address - Phone:216-752-5346
Mailing Address - Fax:
Practice Address - Street 1:21403 CHAGRIN BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5322
Practice Address - Country:US
Practice Address - Phone:216-752-5346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5283103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty