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NPI Code Detail

MEDICARE: MRS. MELISA GRANVILLE LMSW

MEDICARE: MRS. MELISA GRANVILLE 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
1104100000XSocial Worker106938-01NY

General Provider Information

NPI Number : 1811576861
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELISA GRANVILLE LMSW
Provider Business Mailing Address
First Line : 158 PRIMROSE LN
Second Line :
City : EAST AMHERST
State : NY
Zip : 14051-1250
Country : US
Telephone Number : 716-515-8766
Fax Number :
Provider Business Practice Location Address
First Line : 52 WOODSTREAM DR
Second Line :
City : GRAND ISLAND
State : NY
Zip : 14072-1485
Country : US
Telephone Number : 315-427-2528
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2021
Last Update Date : 04/06/2021

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