Individual
DR. MITZIE L GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD.
Contact information
Practice address
4641 ROOSEVELT BLVD, SUITE C229, PHILADELPHIA, PA 19124-2343
(215) 831-4811
(215) 831-2603
Mailing address
1601 CHERRY ST, SUITE 11511, PHILADELPHIA, PA 19102-1321
(215) 255-7822
(215) 255-7825
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PS008501L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001685355
—
PA
Enumeration date
06/09/2006
Last updated
08/31/2016
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