Provider Demographics
NPI:1982319430
Name:GRANGER, PATRICIA EILEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:EILEEN
Last Name:GRANGER
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 1:171 ANDROSS LN
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-2079
Mailing Address - Country:US
Mailing Address - Phone:512-627-7957
Mailing Address - Fax:
Practice Address - Street 1:171 ANDROSS LN
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-2079
Practice Address - Country:US
Practice Address - Phone:512-627-7957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherPRIVATE PRACTICE