=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821985490
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GABRIELLE T GRANT LPCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2025
-----------------------------------------------------
Last Update Date | 06/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 CAMPBELL AVE
-----------------------------------------------------
City | WEST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06516-5014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-503-3000
-----------------------------------------------------
Fax | 203-503-3415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 CLAUDIA DR APT 434
-----------------------------------------------------
City | WEST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06516-3063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-214-5787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 8411
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------