Provider Demographics
NPI:1528397684
Name:GRANT, EMRIS BERNADETTE
Entity Type:Individual
Prefix:
First Name:EMRIS
Middle Name:BERNADETTE
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1709
Mailing Address - Country:US
Mailing Address - Phone:215-906-2885
Mailing Address - Fax:
Practice Address - Street 1:173 HOUSTON RD
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1709
Practice Address - Country:US
Practice Address - Phone:215-906-2885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health