MEDICARE: LANAGRINEVLCSWRPSYCHOTHERAPYPLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1104603240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANAGRINEVLCSWRPSYCHOTHERAPYPLLC

Provider Business Mailing Address
First Line	:	2743 MILL AVE PH
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6421
Country	:	US
Telephone Number	:	347-666-7225
Fax Number	:

Provider Business Practice Location Address
First Line	:	2743 MILL AVE PH
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6421
Country	:	US
Telephone Number	:	347-666-7225
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOTHERAPIST
Name	:	DR. LANA GRINEV
Credential	:	LCSWR
Telephone Number	:	347-666-7225

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	11/21/2025

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