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General NPI Number Information
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NPI Number | 1861964744
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Entity Type | Individual
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Provider Name | PHILLIP RYAN GRANT LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 97 HUNT CLUB DR
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-3984
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Country | US
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Telephone | 610-750-1395
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Fax |
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Provider Business Mailing Address
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Address Line | 97 HUNT CLUB DR
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-3984
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Country | US
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Telephone | 610-750-1395
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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 | CW021613
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW131675
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License Number State | PA
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