Provider Demographics
NPI:1710990221
Name:GRANER, MARTHA (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:GRANER
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 1:7419 NW CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6901
Mailing Address - Country:US
Mailing Address - Phone:503-296-0788
Mailing Address - Fax:503-296-0788
Practice Address - Street 1:811 NW 20TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1443
Practice Address - Country:US
Practice Address - Phone:503-296-0788
Practice Address - Fax:503-296-0788
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2840-LCSW1041C0700X
CA9769-LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR114028Medicare ID - Type Unspecified