MEDICARE: LIANNE GRULLON LMSW

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	104100000X	Social Worker	112977	NY

General Provider Information

NPI Number	:	1396315842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANNE GRULLON LMSW

Provider Business Mailing Address
First Line	:	1326 RIVERSIDE DR APT 1
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-1013
Country	:	US
Telephone Number	:	518-577-5663
Fax Number	:

Provider Business Practice Location Address
First Line	:	1326 RIVERSIDE DR APT 1
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-1013
Country	:	US
Telephone Number	:	518-577-5663
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	01/28/2025

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