Provider Demographics
NPI:1710876255
Name:GRANT, ADAM D
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:D
Last Name:GRANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BETHEL LOOP APT 12G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-1714
Mailing Address - Country:US
Mailing Address - Phone:347-204-6554
Mailing Address - Fax:
Practice Address - Street 1:200 BETHEL LOOP APT 12G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-1714
Practice Address - Country:US
Practice Address - Phone:347-204-6554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker