=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992865307
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL GRANOFF LSCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 10/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4200 SOMERSET DR STE 254
-----------------------------------------------------
City | PRAIRIE VILLAGE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66208-5213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-677-2277
-----------------------------------------------------
Fax | 913-491-8448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4350 SHAWNEE MISSION PKWY SUITE 252
-----------------------------------------------------
City | FAIRWAY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-677-2277
-----------------------------------------------------
Fax | 913-677-2229
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1241
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 006065
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------