Provider Demographics
NPI:1982186466
Name:GRANAHAN, CHRISTINA MCWALTER (LICSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MCWALTER
Last Name:GRANAHAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 SHADOW OAK DR
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3165
Mailing Address - Country:US
Mailing Address - Phone:781-820-1617
Mailing Address - Fax:
Practice Address - Street 1:95 SHADOW OAK DR
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3165
Practice Address - Country:US
Practice Address - Phone:781-820-1617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110202-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110202-SW-LICSWOtherLICSW