Provider Demographics
NPI:1902013568
Name:GRANAT, MARYLIN JOAN (MSW LCSW BCD)
Entity Type:Individual
Prefix:MS
First Name:MARYLIN
Middle Name:JOAN
Last Name:GRANAT
Suffix:
Gender:F
Credentials:MSW LCSW BCD
Other - Prefix:
Other - First Name:MARYLIN
Other - Middle Name:SCHIFF
Other - Last Name:GRANAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW ACSW LCSW BCD
Mailing Address - Street 1:310 CEDAR LANE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666
Mailing Address - Country:US
Mailing Address - Phone:201-712-9520
Mailing Address - Fax:201-843-2763
Practice Address - Street 1:310 CEDAR LANE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:201-712-9520
Practice Address - Fax:201-843-2763
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYBCD 278061041C0700X
NJ44SC000939001041C0700X
NYR03176511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJGR646926Medicare ID - Type Unspecified