Provider Demographics
NPI:1760625438
Name:GRANOTE, ALEEZA CARI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALEEZA
Middle Name:CARI
Last Name:GRANOTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12882 MANCHESTER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1858
Mailing Address - Country:US
Mailing Address - Phone:314-863-9912
Mailing Address - Fax:314-863-9918
Practice Address - Street 1:12882 MANCHESTER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1858
Practice Address - Country:US
Practice Address - Phone:314-863-9912
Practice Address - Fax:314-863-9918
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20090061271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10410000XMedicare Oscar/Certification