Provider Demographics
NPI:1992921274
Name:GRANT, DONNA ETHEL (LICSW,CAS,LADC,RPP)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:ETHEL
Last Name:GRANT
Suffix:
Gender:F
Credentials:LICSW,CAS,LADC,RPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 NEW OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1832
Mailing Address - Country:US
Mailing Address - Phone:617-281-5086
Mailing Address - Fax:
Practice Address - Street 1:31 NEW OCEAN ST
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1832
Practice Address - Country:US
Practice Address - Phone:617-281-5086
Practice Address - Fax:617-281-5086
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10296741041C0700X
MA868101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)