Organization
MLW DEVELOPMENTAL EVALUATION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAROLL GRANT PHD (DIRECTOR/SCHOOL PSYCHOLOGIST)
(315) 472-4404
Entity
Organization
Contact information
Practice address
215 BASSETT ST, SYRACUSE, NY 13210-2113
(315) 472-4404
Mailing address
215 BASSETT ST, SYRACUSE, NY 13210-2113
(315) 472-4404
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
10/17/2012
Last updated
10/17/2012
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