Provider Demographics
NPI:1023793486
Name:GRANADO, ASHTON MONTGOMERY
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:MONTGOMERY
Last Name:GRANADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HORTENSE ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4616
Mailing Address - Country:US
Mailing Address - Phone:203-520-2914
Mailing Address - Fax:
Practice Address - Street 1:20 HORTENSE ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4616
Practice Address - Country:US
Practice Address - Phone:203-520-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling