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

Q: 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.

Q: What is Mitzie Grant's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Mitzie Grant was last updated on August 31, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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: July 26, 2026.

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

On this page

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

Open in Google Maps ↗

Other Identifiers 2

Medicaid001685355PA

Medicare UPINS54047PA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

Leave this field empty