Mitzie L Grant, PHD.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PS008501L Issued in PA

Practice address

4641 Roosevelt Blvd
Suite C229
Philadelphia, PA 19124-2343

Phone

(215) 831-4811

Fax

(215) 831-2603

NPI assigned

Jun 9, 2006

Last updated

Aug 31, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tower Drexel Academic Medical Group LLC

  dba Internal Medicine Tower Health Medical Group Broad Street

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1780227488
  Medicare reassignment NPD
• Tower Drexel Academic Medical Group LLC

  • Sports Medicine (Family Medicine) Physician
  • Philadelphia, PA
  • NPI 1225660095
  NPD
• Tower Drexel Academic Medical Group LLC

  dba Psychiatry Tower Health Medical Group Erie Avenue

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1407499148
  NPD
• Phoenixville Specialty Clinics, LLC

  • Urology Physician
  • Phoenixville, PA
  • NPI 1235229923
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472601600000",
    "number": "1063453439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 CHERRY ST",
            "address_2": "SUITE 11511",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191021321",
            "telephone_number": "215-255-7822",
            "fax_number": "215-255-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4641 ROOSEVELT BLVD",
            "address_2": "SUITE C229",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191242343",
            "telephone_number": "215-831-4811",
            "fax_number": "215-831-2603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "MITZIE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PHD.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2016-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "PA",
            "license": "PS008501L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001685355",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corrine N Grant
• Eleonore Grant, MD
• Karen Grant, LSW
• Kinzya Bernice Grant, MD
• Lance Jeremiah Grant
• Nikia Grant, PA
• Ona H Grant
• Peyton Rose Grant
• Richard Grant, MD
• Richard E Grant, MD

• Clinical Neuropsychologist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Clinical Neuropsychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.