Provider Demographics
NPI:1770809352
Name:GRANNAN, MEARA W (LCSW)
Entity type:Individual
Prefix:
First Name:MEARA
Middle Name:W
Last Name:GRANNAN
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 1:1125 CREEKVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2027
Mailing Address - Country:US
Mailing Address - Phone:502-608-8551
Mailing Address - Fax:
Practice Address - Street 1:2676 CHARLESTOWN RD STE 9
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2574
Practice Address - Country:US
Practice Address - Phone:812-948-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 4609104100000X
IN34005031A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker