Basic Information
| Provider Information | |||||||||
| NPI: | 1225345200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRANT | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | MONROE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 STONEHILL DR | ||||||||
| Address2: | APT. 4E | ||||||||
| City: | STONEHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021803926 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 172 LAFAYETTE ST | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019704815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787441386 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2010 | ||||||||
| LastUpdateDate: | 09/11/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.