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General NPI Number Information
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NPI Number | 1316047244
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Entity Type | Individual
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Provider Name | GORDON M. GRANT PSY.D
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 120 PULPIT HILL RD UNIT 45
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City | AMHERST
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State | MA
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Zip | 01002-4013
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Country | US
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Telephone | 413-230-4310
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Fax | 413-230-4310
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Provider Business Mailing Address
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Address Line | 120 PULPIT HILL RD UNIT 45
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City | AMHERST
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State | MA
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Zip | 01002-4013
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Country | US
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Telephone | 413-230-4310
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Fax | 413-527-3186
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7575 PR
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7575
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License Number State | MA
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