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General NPI Number Information
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NPI Number | 1871358077
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Entity Type | Organization
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Legal Business Name | ALEXANDRA GRANNAN LICSW LLC
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 800 LEXINGTON STREET WALTHAM PLAZA 1070
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City | WALTHAM
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State | MA
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Zip | 02451
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Country | US
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Telephone | 617-520-4115
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Fax |
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Provider Business Mailing Address
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Address Line | 800 LEXINGTON STREET WALTHAM PLAZA 1070
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City | WALTHAM
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State | MA
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Zip | 02451
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER, SOLE MEMBER
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Name | ALEXANDRA GRANNAN
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Credential | LICSW
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Telephone | 617-520-4115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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