MEDICARE: KARINA 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
1	101YS0200X	School Counselor	088963	NY
2	1041C0700X	Clinical Social Worker	087664	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12121986	OTHER		DOB

General Provider Information

NPI Number	:	1417348012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARINA GRANT LCSW

Provider Business Mailing Address
First Line	:	1175 FULTON AVE
Second Line	:	APT 2D
City	:	BRONX
State	:	NY
Zip	:	10456-4320
Country	:	US
Telephone Number	:	646-488-5126
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 JUMEL PL
Second Line	:	RM. A127
City	:	NEW YORK
State	:	NY
Zip	:	10032-4316
Country	:	US
Telephone Number	:	212-923-1495
Fax Number	:

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

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	09/26/2019

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Directions to “ KARINA GRANT LCSW” Practice Location

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