Provider Demographics
NPI:1457767972
Name:GRANT, PHILIP SANCHEZ (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:SANCHEZ
Last Name:GRANT
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 HUGO ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2760
Mailing Address - Country:US
Mailing Address - Phone:310-691-3644
Mailing Address - Fax:866-936-7840
Practice Address - Street 1:139 HUGO ST APT 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2760
Practice Address - Country:US
Practice Address - Phone:310-691-3644
Practice Address - Fax:866-936-7840
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCBA 1-14-15227103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst