NPI 1063453439

Mitzie L Grant, PHD

Practitioner Clinical Neuropsychologist Philadelphia, PA

Practice location

Address: 4641 Roosevelt Blvd Suite C229, Philadelphia, PA 19124-2343
Phone: (215) 831-4811
Fax: (215) 831-2603
Mailing address: 1601 Cherry St Suite 11511, Philadelphia, PA 19102-1321

Registered specialties

Clinical Neuropsychologist Primary

Behavioral Health & Social Service Providers Taxonomy 103G00000X Licence PS008501L (PA)

Other Clinical Neuropsychologist providers in Pennsylvania →

Registry record

NPI: 1063453439
Entity type: Individual
Sex (as registered): Female
NPI issued: 9 Jun 2006
Record last updated: 31 Aug 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.