Provider Demographics
NPI:1336452325
Name:GRANEK, BARRY ALLEN (MS)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:ALLEN
Last Name:GRANEK
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 137TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1915
Mailing Address - Country:US
Mailing Address - Phone:917-584-3739
Mailing Address - Fax:
Practice Address - Street 1:7005 137TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1915
Practice Address - Country:US
Practice Address - Phone:917-584-3739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP69377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health