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General NPI Number Information
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NPI Number | 1790794097
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Entity Type | Individual
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Provider Name | JOSEPH GRANT LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 7731 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60620-2412
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Country | US
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Telephone | 773-962-3737
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Fax |
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Provider Business Mailing Address
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Address Line | 7731 S. HALSTED STREET JESSE BROWN VA MC
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City | CHICAGO
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State | IL
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Zip | 60620-4129
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Country | US
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Telephone | 773-962-3737
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149008076
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License Number State | IL
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