Healthcare Provider Details

I. General information

NPI: 1659020436
Provider Name (Legal Business Name): MELISA GRANOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 PARKER ST
LEXINGTON MA
02421-4917
US

IV. Provider business mailing address

1661 MASSACHUSETTS AVE UNIT 163
LEXINGTON MA
02420-2026
US

V. Phone/Fax

Practice location:
  • Phone: 781-226-4492
  • Fax: 781-903-6783
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1021301
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: