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Individual

DONNA M GRANT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
106 MODOCK RD, POMFRET CTR, CT 06259-1605
(401) 523-4488
Mailing address
106 MODOCK RD, POMFRET CTR, CT 06259-1605
(401) 523-4488

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
011503
CT
1041C0700X
Clinical Social Worker
Primary
011503
CT
1041C0700X
Clinical Social Worker
11503
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
011503
CT
Enumeration date
08/06/2021
Last updated
02/04/2023
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