Provider Demographics
NPI:1760824254
Name:GRANT, TATIANA (LMHC)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:76 DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003
Mailing Address - Country:US
Mailing Address - Phone:516-728-6554
Mailing Address - Fax:
Practice Address - Street 1:70 SUNRISE HWY
Practice Address - Street 2:SUITE 500 #579
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581
Practice Address - Country:US
Practice Address - Phone:516-323-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005479101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health