Provider Demographics
NPI:1992947311
Name:GRANA, PATRICIA LAURA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LAURA
Last Name:GRANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 SAN MATEO BLVD NE STE 170
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3534
Mailing Address - Country:US
Mailing Address - Phone:505-816-6700
Mailing Address - Fax:505-816-6702
Practice Address - Street 1:6211 SAN MATEO BLVD NE STE 170
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3534
Practice Address - Country:US
Practice Address - Phone:505-816-6700
Practice Address - Fax:505-816-6702
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-31531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical