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NPI Code Detail

MEDICARE: MS. MICHELLE GRANDIN LICSW

MEDICARE:  MS. MICHELLE  GRANDIN  LICSW
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 Worker213924MA

General Provider Information

NPI Number : 1598174047
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELLE GRANDIN LICSW
Provider Business Mailing Address
First Line : 57 EAST MAIN STREET
Second Line : SUITE 215
City : WESTBOROUGH
State : MA
Zip : 01581-1457
Country : US
Telephone Number : 513-655-3178
Fax Number :
Provider Business Practice Location Address
First Line : 57 EAST MAIN ST
Second Line : STE 215
City : WESTBOROUGH
State : MA
Zip : 01581-1457
Country : US
Telephone Number : 513-655-3178
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2014
Last Update Date : 06/22/2020

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Directions to “ MS. MICHELLE GRANDIN LICSW” Practice Location

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