Healthcare Provider Details

I. General information

NPI: 1720488331
Provider Name (Legal Business Name): SHARAY T GRANT ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 BLUE OAKS BLVD STE 213
ROSEVILLE CA
95678-7052
US

IV. Provider business mailing address

43845 10TH ST W STE 2B
LANCASTER CA
93534-4800
US

V. Phone/Fax

Practice location:
  • Phone: 661-633-7680
  • Fax:
Mailing address:
  • Phone: 661-940-9094
  • Fax: 661-951-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: