Basic Information
| Provider Information | |||||||||
| NPI: | 1992000186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRANGE | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 SINGLEFOOT RD | ||||||||
| Address2: | |||||||||
| City: | CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018241925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9788528654 | ||||||||
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| Practice Location | |||||||||
| Address1: | 60 ISLAND ST | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018401835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786873700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2011 | ||||||||
| LastUpdateDate: | 01/19/2011 | ||||||||
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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 | 1041C0700X | 116173 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.