Healthcare Provider Details

I. General information

NPI: 1932062379
Provider Name (Legal Business Name): GRANT CHARLES MIGLIORE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 HILTON AVE STE 201
GARDEN CITY NY
11530-2817
US

IV. Provider business mailing address

65 HILTON AVE STE 201
GARDEN CITY NY
11530-2817
US

V. Phone/Fax

Practice location:
  • Phone: 516-798-4070
  • Fax: 516-778-5795
Mailing address:
  • Phone: 516-798-4070
  • Fax: 516-778-5795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number125858
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: