Provider Demographics
NPI:1952875668
Name:GRANIE, BRYAN (MS)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:GRANIE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8651 NW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3327
Mailing Address - Country:US
Mailing Address - Phone:954-632-5456
Mailing Address - Fax:
Practice Address - Street 1:4900 S UNIVERSITY DR STE 200B
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3811
Practice Address - Country:US
Practice Address - Phone:954-632-5456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3520106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist