MEDICARE: DR. JAMES GRANT PH.D.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1598107369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES GRANT PH.D.

Provider Business Mailing Address
First Line	:	53 POND CIR
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-2420
Country	:	US
Telephone Number	:	617-983-0094
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 POND CIR
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-2420
Country	:	US
Telephone Number	:	617-983-0094
Fax Number	:

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

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	07/22/2013

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