Provider Demographics
NPI:1588825244
Name:GRANITA, CATHY A (MSED)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:A
Last Name:GRANITA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MILLENNIUM DR
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-1197
Mailing Address - Country:US
Mailing Address - Phone:585-243-7250
Mailing Address - Fax:585-243-7264
Practice Address - Street 1:4600 MILLENNIUM DR
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1197
Practice Address - Country:US
Practice Address - Phone:585-243-7250
Practice Address - Fax:585-243-7264
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003058103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis