Provider Demographics
NPI:1831863307
Name:GRANT, TAMARA (LCSW)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:GRANT
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 1:40 PUTNAM AVE # 6243
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-9998
Mailing Address - Country:US
Mailing Address - Phone:203-606-8415
Mailing Address - Fax:
Practice Address - Street 1:40 PUTNAM AVE # 6243
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-9998
Practice Address - Country:US
Practice Address - Phone:203-606-8415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040144041041C0700X
CT0114841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039244Medicaid