Healthcare Provider Details

I. General information

NPI: 1134042385
Provider Name (Legal Business Name): JORDANNE GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 LIBERTY ST APT 29
STAMFORD CT
06902-4774
US

IV. Provider business mailing address

59 LIBERTY ST APT 29
STAMFORD CT
06902-4774
US

V. Phone/Fax

Practice location:
  • Phone: 914-343-3945
  • Fax:
Mailing address:
  • Phone: 914-343-3945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8476
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: