MEDICARE: KAREN D. GRANT LCSW

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	1041C0700X	Clinical Social Worker	SW0001962	FL

General Provider Information

NPI Number	:	1982931903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN D. GRANT LCSW

Provider Business Mailing Address
First Line	:	571 LEEWAY TRL
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-2566
Country	:	US
Telephone Number	:	386-871-0736
Fax Number	:	386-258-9889

Provider Business Practice Location Address
First Line	:	571 LEEWAY TRL
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-2566
Country	:	US
Telephone Number	:	386-871-0736
Fax Number	:	386-258-9889

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

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	11/11/2009

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