MEDICARE: JEROME GRANT LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	44SL06771900	NJ
2	1041C0700X	Clinical Social Worker	44SC06586800	NJ

General Provider Information

NPI Number	:	1154100329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME GRANT LSW

Provider Business Mailing Address
First Line	:	6360 MARYLAND AVE
Second Line	:
City	:	MAYS LANDING
State	:	NJ
Zip	:	08330-1047
Country	:	US
Telephone Number	:	609-319-7617
Fax Number	:

Provider Business Practice Location Address
First Line	:	6360 MARYLAND AVE
Second Line	:
City	:	MAYS LANDING
State	:	NJ
Zip	:	08330-1047
Country	:	US
Telephone Number	:	609-319-7617
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	12/07/2025

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Directions to “ JEROME GRANT LSW” Practice Location

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