Provider Demographics
NPI:1891685228
Name:GRANOZIO (GILES), MARY ELLEN (MS, LSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELLEN
Last Name:GRANOZIO (GILES)
Suffix:
Gender:F
Credentials:MS, LSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:GILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 MAIDSTONE CT
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2221
Mailing Address - Country:US
Mailing Address - Phone:609-577-9615
Mailing Address - Fax:
Practice Address - Street 1:3 MAIDSTONE CT
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2221
Practice Address - Country:US
Practice Address - Phone:609-577-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07176600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker