Provider Demographics
NPI:1710995600
Name:GRANT, MIRANDA SOMJIT (LICSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:SOMJIT
Last Name:GRANT
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9006 DANGERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4600
Mailing Address - Country:US
Mailing Address - Phone:202-423-7812
Mailing Address - Fax:
Practice Address - Street 1:9006 DANGERFIELD PL
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4600
Practice Address - Country:US
Practice Address - Phone:202-423-7812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125091041C0700X
DCLC3036531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical