Healthcare Provider Details

I. General information

NPI: 1710817523
Provider Name (Legal Business Name): KRISTEN GRANIERI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BROAD ST APT 2445
STAMFORD CT
06901-2074
US

IV. Provider business mailing address

200 BROAD ST APT 2445
STAMFORD CT
06901-2074
US

V. Phone/Fax

Practice location:
  • Phone: 516-641-0851
  • Fax:
Mailing address:
  • Phone: 516-641-0851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2353
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: