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NPI Code Detail

MEDICARE: MOLLY GRANT MSW, LISW-S

MEDICARE: MOLLY GRANT MSW, LISW-S
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
11041C0700XClinical Social WorkerPO12133NC

General Provider Information

NPI Number : 1164908166
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY GRANT MSW, LISW-S
Provider Business Mailing Address
First Line : 243 ORVILLE ST APT 11
Second Line :
City : FAIRBORN
State : OH
Zip : 45324-2941
Country : US
Telephone Number : 508-562-0491
Fax Number :
Provider Business Practice Location Address
First Line : 175 S MAIN ST
Second Line :
City : CENTERVILLE
State : OH
Zip : 45458-2372
Country : US
Telephone Number : 937-434-0540
Fax Number : 937-434-6726
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2018
Last Update Date : 01/22/2024

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