Provider Demographics
NPI:1588922777
Name:GRANGER-PORTER, DARAH E
Entity type:Individual
Prefix:DR
First Name:DARAH
Middle Name:E
Last Name:GRANGER-PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DARAH
Other - Middle Name:E
Other - Last Name:GRANGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1857 WELLS RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2338
Mailing Address - Country:US
Mailing Address - Phone:904-534-4441
Mailing Address - Fax:
Practice Address - Street 1:1857 WELLS RD
Practice Address - Street 2:SUITE 222
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2338
Practice Address - Country:US
Practice Address - Phone:904-534-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8249103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist