Active NPI
Renae Lynn Grant, PHD
- Psychologist
- Arlington, MA
National Provider Identifier
1104964741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 4048
- Practice address
- 32 Amherst St
Arlington, MA 02474-3409 - Phone
- (781) 646-8450
- NPI assigned
- Feb 4, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 4048 | MA | Primary |
| Psychologist | 103T00000X | 529 | NH |
Addresses
Primary practice location
32 Amherst St
Arlington, MA 02474-3409
Mailing address
32 Amherst St
Arlington, MA 02474-3409
Phone (781) 646-8450
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4048 | MA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104964741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32 AMHERST ST",
"city": "ARLINGTON",
"state": "MA",
"postal_code": "024743409",
"telephone_number": "781-646-8450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "32 AMHERST ST",
"city": "ARLINGTON",
"state": "MA",
"postal_code": "024743409",
"telephone_number": "781-646-8450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "RENAE",
"middle_name": "LYNN",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "4048",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NH",
"license": "529",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arlington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.