Healthcare Provider Details

I. General information

NPI: 1033284815
Provider Name (Legal Business Name): MICHAEL F MCGRANE MSW LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22797 MEADOWBROOK AVE N
SCANDIA MN
55073-9429
US

IV. Provider business mailing address

22797 MEADOWBROOK AVE N
SCANDIA MN
55073-9429
US

V. Phone/Fax

Practice location:
  • Phone: 651-491-9953
  • Fax:
Mailing address:
  • Phone: 651-491-9953
  • Fax:

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: