Grant, Mitzie L
Grant, Mitzie L is an individual health care provider with primary practice located at 4641 Roosevelt Blvd Suite C229, Philadelphia PA 19124-2343. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Neuropsychologist, which is considered as her primary health care specialty. Grant, Mitzie L can be contacted via phone (215) 831-4811.Contact Information
Primary practice address
4641 Roosevelt Blvd Suite C229
Philadelphia PA 19124-2343
Phone: (215) 831-4811
Fax: (215) 831-2603
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical Neuropsychologist | 103G00000X | PS008501L | Pennsylvania |
Profile Details
| NPI number | 1063453439 |
|---|---|
| LBN Legal business name | Grant, Mitzie L |
| Credentials | PHD. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 9th, 2006 |
| Last updated | Aug 31st, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063453439 | NPPES |
| Pennsylvania | MEDICAID | 001685355 |
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