Healthcare Provider Details

I. General information

NPI: 1609150093
Provider Name (Legal Business Name): LEVI GRANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 W CENTRAL ST STE 4
NATICK MA
01760-4561
US

IV. Provider business mailing address

13 W CENTRAL ST STE 4
NATICK MA
01760-4561
US

V. Phone/Fax

Practice location:
  • Phone: 617-359-3472
  • Fax:
Mailing address:
  • Phone: 617-359-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: