Provider Demographics
NPI:1790794097
Name:GRANT, JOSEPH (LCSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:GRANT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7731 S. HALSTED STREET
Mailing Address - Street 2:JESSE BROWN VA MC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-4129
Mailing Address - Country:US
Mailing Address - Phone:773-962-3737
Mailing Address - Fax:
Practice Address - Street 1:7731 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-2412
Practice Address - Country:US
Practice Address - Phone:773-962-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490080761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical