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General NPI Number Information
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NPI Number | 1083956957
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Entity Type | Individual
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Provider Name | GRANT PIKE DSW, LICSW
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Gender | Male
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 01/24/2026
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Provider Practice Location Address
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Address Line | 779 WASHINGTON ST STE 3C
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City | CANTON
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State | MA
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Zip | 02021-3022
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Country | US
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Telephone | 617-398-7080
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Fax |
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Provider Business Mailing Address
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Address Line | 36 N BEDFORD ST # C22
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City | EAST BRIDGEWATER
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State | MA
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Zip | 02333-1186
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Country | US
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Telephone | 508-992-6553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 123398
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 224419
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License Number State | MA
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