Provider Demographics
NPI:1487148698
Name:GRANT, CARMEN SOFIA (LCSW-C)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:SOFIA
Last Name:GRANT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:MONCADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 HARGRAVES DR
Mailing Address - Street 2:
Mailing Address - City:FEDERALSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21632-1088
Mailing Address - Country:US
Mailing Address - Phone:410-754-9021
Mailing Address - Fax:833-908-2285
Practice Address - Street 1:320 HARGRAVES DR
Practice Address - Street 2:
Practice Address - City:FEDERALSBURG
Practice Address - State:MD
Practice Address - Zip Code:21632-1088
Practice Address - Country:US
Practice Address - Phone:410-754-9021
Practice Address - Fax:833-908-2285
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA989521041C0700X
MD323891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical