Provider Demographics
NPI:1316047244
Name:GRANT, GORDON M (PSYD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:M
Last Name:GRANT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 PULPIT HILL RD UNIT 45
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-4013
Mailing Address - Country:US
Mailing Address - Phone:413-230-4310
Mailing Address - Fax:413-527-3186
Practice Address - Street 1:120 PULPIT HILL RD UNIT 45
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-4013
Practice Address - Country:US
Practice Address - Phone:413-230-4310
Practice Address - Fax:413-230-4310
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA7575 PR103TC0700X
MA7575103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGRW50985Medicare UPIN