Provider Demographics
NPI:1841325867
Name:GRANT, JENNIFER ANN (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
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 1:550 GOSHEN RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-2405
Mailing Address - Country:US
Mailing Address - Phone:860-567-9423
Mailing Address - Fax:860-567-3479
Practice Address - Street 1:550 GOSHEN RD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-2405
Practice Address - Country:US
Practice Address - Phone:860-567-9423
Practice Address - Fax:860-567-3479
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0061661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical