Provider Demographics
NPI:1386197838
Name:GRANZOW, MELODY RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:RENEE
Last Name:GRANZOW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:RENEE
Other - Last Name:ROUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MELODY ROUTH
Mailing Address - Street 1:3800 W BAY TO BAY BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6844
Mailing Address - Country:US
Mailing Address - Phone:813-906-9117
Mailing Address - Fax:
Practice Address - Street 1:3800 W BAY TO BAY BLVD STE 12
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6844
Practice Address - Country:US
Practice Address - Phone:813-906-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker