Organization
GRANITE HOUSE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SPENCER L GEAR LCSW-C (EXECUTIVE DIRECTOR)
(410) 876-3007
Entity
Organization
Contact information
Practice address
288 E GREEN ST, WESTMINSTER, MD 21157-5410
(410) 876-3007
(410) 751-7797
Mailing address
288 E GREEN ST, WESTMINSTER, MD 21157-5410
(410) 876-3007
(410) 751-7797
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
MD
261QR0400X
Rehabilitation Clinic/Center
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2095968
AETNA
MD
01
—
T595
BLUE CROSS BLUE SHIELD FE
MD
Enumeration date
07/15/2006
Last updated
08/08/2007
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