Basic Information
| Provider Information | |||||||||
| NPI: | 1639395049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRANT | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1871 REDWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443013224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307241580 | ||||||||
| FaxNumber: | 3308670056 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 N MILLER RD | ||||||||
| Address2: | |||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443333702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308670066 | ||||||||
| FaxNumber: | 3308670056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I 97100 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.