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NPI Code Detail

MEDICARE: MELISSA GRANT LCSW

MEDICARE: MELISSA GRANT LCSW
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1376916825
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA GRANT LCSW
Provider Business Mailing Address
First Line : PO BOX 25445
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87125-0445
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 901 RIO GRANDE BLVD NW STE G252
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87104-2050
Country : US
Telephone Number : 505-221-6578
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2015
Last Update Date : 10/24/2023

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Directions to “ MELISSA GRANT LCSW” Practice Location

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