Healthcare Provider Details

I. General information

NPI: 1083956957
Provider Name (Legal Business Name): GRANT PIKE DSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 ROUND COVE RD
CHATHAM MA
02633-1247
US

IV. Provider business mailing address

284 ROUND COVE RD
CHATHAM MA
02633-1247
US

V. Phone/Fax

Practice location:
  • Phone: 617-398-7080
  • Fax:
Mailing address:
  • Phone: 617-398-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123398
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number224419
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: