Healthcare Provider Details

I. General information

NPI: 1710523162
Provider Name (Legal Business Name): LAURA GRYNIEWICH-FRANKLIN LCSW-C, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 PARSON CT
RED LION PA
17356-9417
US

IV. Provider business mailing address

2074 PARSON CT
RED LION PA
17356-9417
US

V. Phone/Fax

Practice location:
  • Phone: 443-758-8930
  • Fax:
Mailing address:
  • Phone: 443-758-8930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18521
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: