Individual
DR. GRANT LOREN IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
HOME BASE PROGRAM, 101 MERRIMAC STREET, 2ND FLOOR, BOSTON, MA 02114
(617) 573-2770
Mailing address
HOME BASE PROGRAM, 101 MERRIMAC STREET, 2ND FLOOR, BOSTON, MA 02114
(617) 573-2770
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
9828
MA
103TC0700X
Clinical Psychologist
9828
MA
Other
Enumeration date
06/30/2014
Last updated
07/02/2014
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