Provider Demographics
NPI:1831907120
Name:GRANBY, FELITA Y
Entity type:Individual
Prefix:MRS
First Name:FELITA
Middle Name:Y
Last Name:GRANBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OX RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-1706
Mailing Address - Country:US
Mailing Address - Phone:917-699-0494
Mailing Address - Fax:
Practice Address - Street 1:407 NEW ROCHELLE RD
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4415
Practice Address - Country:US
Practice Address - Phone:917-699-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty