Healthcare Provider Details

I. General information

NPI: 1457577850
Provider Name (Legal Business Name): LAURA A GRANATO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7640 PROVINCIAL DR
MC LEAN VA
22102-7641
US

IV. Provider business mailing address

19964 HAZELTINE PL
ASHBURN VA
20147-4132
US

V. Phone/Fax

Practice location:
  • Phone: 703-636-1200
  • Fax: 703-636-1300
Mailing address:
  • Phone: 703-636-1200
  • Fax: 703-636-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002672
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000710
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: