Provider Demographics
NPI:1063756518
Name:GRANAHAN, CLAUDETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:CLAUDETTE
Middle Name:
Last Name:GRANAHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12356 NORTHUP WAY
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1956
Mailing Address - Country:US
Mailing Address - Phone:425-861-4477
Mailing Address - Fax:
Practice Address - Street 1:12356 NORTHUP WAY
Practice Address - Street 2:SUITE # 105
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1956
Practice Address - Country:US
Practice Address - Phone:425-861-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-22
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003426103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical