Provider Demographics
NPI:1992939078
Name:GRANT, BREANNA ELIZABETH (MSW)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:ELIZABETH
Last Name:GRANT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HERKIMER ST
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-1712
Mailing Address - Country:US
Mailing Address - Phone:607-351-2032
Mailing Address - Fax:315-464-3134
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2342
Practice Address - Country:US
Practice Address - Phone:315-464-3145
Practice Address - Fax:315-464-3134
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker