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NPI Code Detail

MEDICARE: LANCE JEREMIAH GRANT

MEDICARE: LANCE JEREMIAH GRANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystBH007824PA

General Provider Information

NPI Number : 1366392391
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANCE JEREMIAH GRANT
Provider Business Mailing Address
First Line : 6004 MASTER ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19151-4427
Country : US
Telephone Number : 267-295-2234
Fax Number :
Provider Business Practice Location Address
First Line : 6004 MASTER ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19151-4427
Country : US
Telephone Number : 267-295-2234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2026
Last Update Date : 02/02/2026

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Directions to “ LANCE JEREMIAH GRANT ” Practice Location

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