Provider Demographics
NPI:1205349495
Name:GRANATA, ANNE MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:
Last Name:GRANATA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 YORK ST # EP10-635
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-688-2195
Mailing Address - Fax:203-688-2395
Practice Address - Street 1:YNHH 20 YORK STREET PEDIATRIC ED
Practice Address - Street 2:20 YORK STREET
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3202
Practice Address - Country:US
Practice Address - Phone:203-688-2195
Practice Address - Fax:203-688-2395
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT74101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical