Individual
JACKQUELIN MARIE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LP-MHC
Contact information
Practice address
26 COURT ST STE 409, BROOKLYN, NY 11242-1134
(212) 405-2685
Mailing address
510 W 52ND ST APT 19F, NEW YORK, NY 10019-5298
(646) 284-6394
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
020226
NY
Other
Enumeration date
06/19/2023
Last updated
06/19/2023
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