Provider Demographics
NPI:1609848795
Name:GRANT, ABIGAIL P (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:P
Last Name:GRANT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 MAYFIELD RD STE 216
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2692
Mailing Address - Country:US
Mailing Address - Phone:216-331-5498
Mailing Address - Fax:216-331-5498
Practice Address - Street 1:5010 MAYFIELD RD STE 216
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2692
Practice Address - Country:US
Practice Address - Phone:216-331-5498
Practice Address - Fax:216-331-5498
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00016011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI0001601OtherSTATE LICENSE CERTIFICATI
OHI0001601OtherSTATE LICENSE CERTIFICATI