Provider Demographics
NPI:1457577850
Name:GRANATO, LAURA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:GRANATO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 HEMLOCK FARMS
Mailing Address - Street 2:
Mailing Address - City:LORDS VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-9115
Mailing Address - Country:US
Mailing Address - Phone:703-636-1200
Mailing Address - Fax:703-636-1300
Practice Address - Street 1:1593 SPRING HILL RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2245
Practice Address - Country:US
Practice Address - Phone:703-636-1200
Practice Address - Fax:703-636-1300
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002672101YP2500X
VA0717000710106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAS297OtherBCBS
VA103501OtherANTHEM
VA103501OtherANTHEM