Active NPI
Laura Diane Maynard Grant, PSYD
- Clinical Psychologist
- South Hadley, MA
National Provider Identifier
1174936231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 9903
- Practice address
- 7 Hadley St
Suite 4
South Hadley, MA 01075-1147 - Phone
- (786) 269-7819
- Fax
- (413) 437-7826
- NPI assigned
- Jun 6, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 9903 | MA | Primary |
| Clinical Psychologist | 103TC0700X | 05078 | MD |
Addresses
Primary practice location
7 Hadley St
Suite 4
South Hadley, MA 01075-1147
Mailing address
7 Hadley St
Suite 4
South Hadley, MA 01075-1147
Phone (786) 269-7819
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9903 | MA | MD | Mental Health Counselor |
| 05078 | MD | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Champions Wellness LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- South Hadley, MA
- NPI 1851706097
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402012800000",
"number": "1174936231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 HADLEY ST",
"address_2": "SUITE 4",
"city": "SOUTH HADLEY",
"state": "MA",
"postal_code": "010751147",
"telephone_number": "786-269-7819",
"fax_number": "413-437-7826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 HADLEY ST",
"address_2": "SUITE 4",
"city": "SOUTH HADLEY",
"state": "MA",
"postal_code": "010751147",
"telephone_number": "786-269-7819",
"fax_number": "413-437-7826"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "LAURA",
"middle_name": "DIANE MAYNARD",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-06",
"last_updated": "2014-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "9903",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "05078",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Hadley, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.