Provider Demographics
NPI:1922782408
Name:GRANICK, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:GRANICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-4724
Mailing Address - Country:US
Mailing Address - Phone:570-579-6984
Mailing Address - Fax:
Practice Address - Street 1:500 OFFICE CENTER DR
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3219
Practice Address - Country:US
Practice Address - Phone:215-540-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional