Healthcare Provider Details

I. General information

NPI: 1902080393
Provider Name (Legal Business Name): MR. JESSE GRANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOWARD ST
FRAMINGHAM MA
01702-8313
US

IV. Provider business mailing address

85 CLARKE RD
NEEDHAM MA
02492-1333
US

V. Phone/Fax

Practice location:
  • Phone: 508-879-2250
  • Fax: 508-620-2637
Mailing address:
  • Phone: 781-237-0350
  • Fax: 508-620-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: