Provider Demographics
NPI:1790909810
Name:GRANT, DONNA J (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:GRANT
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 ROCKINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2516
Mailing Address - Country:US
Mailing Address - Phone:585-442-3050
Mailing Address - Fax:
Practice Address - Street 1:328 ROCKINGHAM ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2516
Practice Address - Country:US
Practice Address - Phone:585-442-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR030064-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P010030064OtherEXCELLUS
7608371OtherAETNA
NYIA1227OtherPTAN
NYIA1227OtherPTAN