Provider Demographics
NPI:1295088789
Name:GRANAHAN, RICHARD BRAYE (MSW)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BRAYE
Last Name:GRANAHAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LUCY DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01540-2854
Mailing Address - Country:US
Mailing Address - Phone:781-551-0999
Mailing Address - Fax:781-551-3396
Practice Address - Street 1:89 ACCESS RD STE 24
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5233
Practice Address - Country:US
Practice Address - Phone:781-551-0999
Practice Address - Fax:781-551-3396
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-21
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1047561041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA881397729OtherNASW