Provider Demographics
NPI:1578239315
Name:GRANDY, MEGHAN (LCSW)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:GRANDY
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OXFORD PARK
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-1509
Mailing Address - Country:US
Mailing Address - Phone:315-409-8119
Mailing Address - Fax:
Practice Address - Street 1:4 AUTOMATION LN
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1672
Practice Address - Country:US
Practice Address - Phone:518-327-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113367104100000X
NY0994701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker