DR. MITZIE L GRANT (NPI# 1063453439) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063453439 |
| Entity Type | Individual |
| Full Name | DR. MITZIE L GRANT |
| Credential | PHD. |
| Practice Address |
4641 Roosevelt Blvd Suite C229 Philadelphia PA 19124-2343 |
| Mailing Address |
1601 Cherry St Suite 11511 Philadelphia PA 19102-1321 |
| Practice Telephone | 2158314811 |
| Practice Fax Number | 2158312603 |
| Mailing Telephone | 2152557822 |
| Mailing Fax Number | 2152557825 |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2016-08-31 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | PS008501L | PA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 001685355 | 05 |
| Street Address |
4641 ROOSEVELT BLVD SUITE C229 |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19124-2343 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710972161 | Katherine B. Frantz | Psychiatry & Neurology | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2005-09-13 |
| 1770109407 | Amy Fisher | Social Worker | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2020-06-18 |
| 1518583426 | Holly Albaugh | Social Worker | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2020-06-17 |
| 1700401809 | Brittany Arnao | Social Worker | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2398 | 2020-06-15 |
| 1255963047 | Kathleen Cuffy | Registered Nurse | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2020-02-10 |
| 1922641620 | Tower Drexel Academic Medical Group LLC | Psychiatry & Neurology | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2019-10-25 |
| 1871153809 | Roya Bina | Psychiatry & Neurology | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2019-06-20 |
| 1427522937 | Path (people Acting To Help), Inc. | Community Based Residential Treatment Facility, Mental Illness | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2019-01-17 |
| 1609355387 | Samantha Diane Coppola | Counselor | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2018-08-13 |
| 1841785136 | Lauren Newman | Social Worker | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2018-06-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831749308 | William Mark Hanna Sr. | Pharmacist | 4600 Rooselvelt Blvd Bldg G, Philadelphia, PA 19124 | 2019-09-17 |
| 1881256451 | Medical Discovery Systems, LLC | Durable Medical Equipment & Medical Supplies | 5425 Oxford Ave., 5425 Oxford Ave. Suite (3 A), Philadelphia, PA 19124 | 2019-07-03 |
| 1548731391 | Sierra Pinkney | Registered Nurse | 1615 Granite St, Philadelphia, PA 19124 | 2018-12-05 |
| 1922507987 | Xavier Sergio Henriquez | Counselor | 4510 Frankford Avenue 2nd Floor, Philadelphia, PA 19124 | 2018-02-06 |
| 1558881581 | Isabel Cristina Castillo Hernandez | Pediatrics | 4500-10, Apt 201b, Philadelphia, PA 19124 | 2017-06-21 |
| 1952843732 | Patrick Grugan | Social Worker | Roosevelt Boulevard & Adams Avenue, Philadelphia, PA 19124 | 2016-11-10 |
| 1811340482 | Katarzyna Liwski | Psychiatry & Neurology | 4641 Roosevelt Boulevard, E212, Drexel University College of Medicine Friends Hospital, Philadelphia, PA 19124 | 2016-07-19 |
| 1851769327 | Aleka Kostouros | Social Worker | Roosevelt Blvd & Adams Ave, Northeast Community Center for Behavioral Health, Philadelphia, PA 19124 | 2015-09-14 |
| 1407230378 | Sara Bachani | Psychiatry & Neurology | 4641 Roosevelt Blvd, Friends Hospital, Room 231, Philadelphia, PA 19124 | 2015-07-10 |
| 1215327051 | Alyssa Renee Kirk | Counselor | 4500-10 Frankford Ave, 2nd Floor, Philadelphia, PA 19124 | 2015-02-02 |
| Find all providers in zip 19124 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467092312 | Katie Fabius | Clinical Neuropsychologist | 230 S Broad St Ste 1005, Philadelphia, PA 19102-4105 | 2020-01-08 |
| 1609228022 | Michael E. Keesler | Clinical Neuropsychologist | 77 Rochelle Ave, Philadelphia, PA 19128-3809 | 2016-07-09 |
| 1023463106 | Chelsea Black | Clinical Neuropsychologist | 3405 Civic Center Blvd Rm 107, Philadelphia, PA 19104-4319 | 2016-04-26 |
| 1285088914 | Megan Alana Perrin | Clinical Neuropsychologist | 1510 Manton St, Philadelphia, PA 19146-3129 | 2016-04-19 |
| 1104207190 | Kelly M. Janke | Clinical Neuropsychologist | 3501 Civic Center Blvd # 10209, Philadelphia, PA 19104-3820 | 2015-06-15 |
| 1861637381 | Dr. Shan Psychiatry Clinic LLC | Clinical Neuropsychologist | 756 Adams Ave, Philadelphia, PA 19124-2330 | 2008-12-12 |
| 1225184468 | Cornelius Furgueson | Clinical Neuropsychologist | 1801 Vine St, Room 149-mg, Philadelphia, PA 19103-1117 | 2007-01-27 |
| 1588711006 | Diversified Psychological Resources, P.C. | Clinical Neuropsychologist | 230 S. Broad St., Suite 1005, Philadelphia, PA 19102-4105 | 2007-01-05 |
| 1407879430 | Carol L Armstrong | Clinical Neuropsychologist | 100 N 20th St, Philadelphia, PA 19103-1443 | 2006-07-25 |
| 1558381251 | Edward A Maitz | Clinical Neuropsychologist | 117 S 17th St, Suite 1700, Philadelphia, PA 19103-5025 | 2006-07-19 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19124 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.