Healthcare Provider Details

I. General information

NPI: 1245177112
Provider Name (Legal Business Name): KEVIN GRANATA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 ROCKY RIVER DR
CLEVELAND OH
44111-4153
US

IV. Provider business mailing address

675 GARDEN ST
TRUMBULL CT
06611-3620
US

V. Phone/Fax

Practice location:
  • Phone: 216-938-9435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2607942
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: