Provider Demographics
NPI:1780838383
Name:GRANVILLE, DILCIA M (LMSW)
Entity Type:Individual
Prefix:DR
First Name:DILCIA
Middle Name:M
Last Name:GRANVILLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 STUYVESANT ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4438
Mailing Address - Country:US
Mailing Address - Phone:516-984-3560
Mailing Address - Fax:718-662-5665
Practice Address - Street 1:1623 STUYVESANT ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4438
Practice Address - Country:US
Practice Address - Phone:516-984-3560
Practice Address - Fax:718-662-5665
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070311104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker