MEDICARE: MISS KATHERINE MARGARET GRANT LMSW

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	121868-01	NY

General Provider Information

NPI Number	:	1760259931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATHERINE MARGARET GRANT LMSW

Provider Business Mailing Address
First Line	:	768 DELAWARE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14209-2006
Country	:	US
Telephone Number	:	716-882-3151
Fax Number	:

Provider Business Practice Location Address
First Line	:	376 HUDSON ST APT 2
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14201-1776
Country	:	US
Telephone Number	:	716-807-7426
Fax Number	:

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

Provider Enumeration Date	:	12/07/2023
Last Update Date	:	02/29/2024

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