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DR. MITZIE L GRANT PHD.
NPI 1063453439
Clinical Neuropsychologist in Philadelphia, PA

Active since June 09, 2006PECOS Enrolled
4641 ROOSEVELT BLVD, SUITE C229, PHILADELPHIA, PA 19124(215) 831-4811(215) 831-2603 Get Directions Write a Review

NPPES record last updated: August 31, 2016. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Aug 31, 2016, May 12, 2016 (2 updates tracked since 2016).

About Dr. Mitzie L Grant Phd. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MITZIE L GRANT PHD. (NPI 1063453439) is an individual clinical neuropsychologist in Philadelphia, Pennsylvania, licensed in Pennsylvania (PS008501L) and active in the NPI registry since June 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063453439
Entity TypeIndividualFemale
Primary Taxonomy103G00000X
Provider Legal NameDR. MITZIE L GRANTCredential: PHD.
Location Address4641 ROOSEVELT BLVD, SUITE C229Philadelphia, PA 19124-2343
Mailing Address1601 Cherry St, Suite 11511Philadelphia, PA 19102-1321 · (215) 255-7822 · Fax (215) 255-7825
Phone(215) 831-4811
Fax(215) 831-2603
Sole ProprietorNo
Enumeration DateJune 9, 2006
Last NPPES UpdateAugust 31, 20162 updates tracked since enumeration
✔ NPI 1063453439 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinical NeuropsychologistBehavioral Health & Social Service Providers
Taxonomy Code103G00000X
License✔ Licensed in PA · PS008501L
Definition
A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.
4641 ROOSEVELT BLVD, Philadelphia, PA 19124
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Other Identifiers 2

Medicaid001685355PA
Medicare UPINS54047PA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Mitzie L Grant Phd. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Mitzie Grant reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Tower Drexel Academic Medical Group LLC
1.8 mi
Psychiatry
160 E ERIE AVE FL 2
Philadelphia, PA 19134
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 48 clinicians in this Medicare group
NPI 1407499148 (610) 743-6049

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ADAM LEVINE LCSW
Social Worker
4641 ROOSEVELT BLVD, ORLEANS BUILDING
PHILADELPHIA, PA 19124
Philadelphia County (215) 831-2899
FRIENDS BEHAVIORAL HEALTH SYSTEM, LP
Psychiatric Hospital
4641 ROOSEVELT BLVD
PHILADELPHIA, PA 19124
Philadelphia County (215) 831-4600
PAUL BALLAS
Psychiatry & Neurology (Psychiatry)
4641 ROOSEVELT BLVD
PHILADELPHIA, PA 19124
Philadelphia County (215) 831-7935
COURTNEY DOUDS LSW, MED
Social Worker
4641 ROOSEVELT BLVD
PHILADELPHIA, PA 19124
Philadelphia County (215) 831-2860
MR. JAMIYLAH SIKA BURNS PHYSICAL THERAPIST
Physical Therapist (Pediatrics)
4641 ROOSEVELT BLVD
PHILADELPHIA, PA 19124
Philadelphia County (215) 742-7820
CHRISTEN JOESELL YASSIN
Social Worker
4641 ROOSEVELT BLVD, ORLEANS BLDG
PHILADELPHIA, PA 19124
Philadelphia County (215) 831-2836
MRS. MARIANN MONTELEONE RN
Registered Nurse (Psychiatric/Mental Health)
4641 ROOSEVELT BLVD
PHILADELPHIA, PA 19124
Philadelphia County (215) 831-2964
NORTHEAST COMMUNITY CENTER FOR MH/MR
Residential Treatment Facility, Intellectual and/or Developmental Disabilities
4641 ROOSEVELT BLVD, ORLEANS BUILDING
PHILADELPHIA, PA 19124
Philadelphia County (215) 831-2800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mitzie Grant's NPI number?

The NPI number for Mitzie Grant is 1063453439. It was assigned to this individual provider in the NPPES registry on June 9, 2006.

Where is Mitzie Grant located?

Mitzie Grant practices at 4641 Roosevelt Blvd Suite C229, Philadelphia, PA 19124. The listed phone number is (215) 831-4811.

What is Mitzie Grant's specialty?

The primary specialty registered for this NPI is Clinical Neuropsychologist with taxonomy code 103G00000X.

Is Mitzie Grant enrolled in Medicare?

Yes. Mitzie Grant is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mitzie Grant's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mitzie Grant reassigns Medicare benefits to Tower Drexel Academic Medical Group LLC (Philadelphia, PA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mitzie Grant's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mitzie Grant accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Buckeye Health Plan list Mitzie Grant as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mitzie Grant was last updated on August 31, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.