Provider Demographics
NPI:1689899254
Name:GRENADIER, STEPHANIE JANE (LMHC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JANE
Last Name:GRENADIER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WHITCOMB AVE
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3384
Mailing Address - Country:US
Mailing Address - Phone:781-749-2401
Mailing Address - Fax:
Practice Address - Street 1:8 BROOKSIDE RD
Practice Address - Street 2:REAR UNIT
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5106
Practice Address - Country:US
Practice Address - Phone:781-843-0111
Practice Address - Fax:781-843-0111
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health