MEDICARE: EMELYN GRANDE CSW-I

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	104100000X	Social Worker		NV
2	104100000X	Social Worker	IC-1576	NV

General Provider Information

NPI Number	:	1740850791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMELYN GRANDE CSW-I

Provider Business Mailing Address
First Line	:	11380 S VIRGINIA ST APT 834
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-9017
Country	:	US
Telephone Number	:	978-559-1080
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 W LIBERTY ST
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89501-2012
Country	:	US
Telephone Number	:	978-559-1080
Fax Number	:

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

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	06/30/2021

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Directions to “ EMELYN GRANDE CSW-I” Practice Location

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