1316118847 NPI number — JASMINE J GRANT LCPC

Table of content: JASMINE J GRANT LCPC (NPI 1316118847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316118847 NPI number — JASMINE J GRANT LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANT
Provider First Name:
JASMINE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316118847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2931 E BIDDLE ST
Provider Second Line Business Mailing Address:
PATIENT ACCOUNTING
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21213-3939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-923-1886
Provider Business Mailing Address Fax Number:
443-923-1895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 N BROADWAY
Provider Second Line Business Practice Location Address:
KENNEDY KRIEGER INSTITUTE
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21205-1832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-923-9200
Provider Business Practice Location Address Fax Number:
443-923-9405
Provider Enumeration Date:
03/12/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  AC0994 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LC2213 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)