Provider Demographics
NPI:1790059103
Name:GRANICK, DEBORAH (LCSW, RN, PMHNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GRANICK
Suffix:
Gender:F
Credentials:LCSW, RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 TERRA COTTA DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-6254
Mailing Address - Country:US
Mailing Address - Phone:314-413-1391
Mailing Address - Fax:
Practice Address - Street 1:1001 NAVAJO
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:919-856-4703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCO105141041C0700X
MO20100120641041C0700X
MO2010004568163WC1500X
NC293967163WC1500X
NC5009850363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health