Provider Demographics
NPI:1992865307
Name:GRANOFF, MICHAEL (LSCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GRANOFF
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 SHAWNEE MISSION PKWY
Mailing Address - Street 2:SUITE 252
Mailing Address - City:FAIRWAY
Mailing Address - State:KS
Mailing Address - Zip Code:66205
Mailing Address - Country:US
Mailing Address - Phone:913-677-2277
Mailing Address - Fax:913-677-2229
Practice Address - Street 1:4200 SOMERSET DR
Practice Address - Street 2:STE 254
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5213
Practice Address - Country:US
Practice Address - Phone:913-677-2277
Practice Address - Fax:913-491-8448
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12411041C0700X
MO0060651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200400620AMedicaid
29164021OtherBCBS OF KC
000D784Medicare ID - Type Unspecified
KS200400620AMedicaid