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NPI Code Detail

MEDICARE: MS. GRACE A BLUEROCK LCSW

MEDICARE: MS. GRACE A BLUEROCK LCSW
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
11041C0700XClinical Social Worker4875TN

General Provider Information

NPI Number : 1598959983
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. GRACE A BLUEROCK LCSW
Provider Business Mailing Address
First Line : 5651 FRIST BLVD STE 712
Second Line :
City : HERMITAGE
State : TN
Zip : 37076-2061
Country : US
Telephone Number : 615-872-9966
Fax Number : 615-872-9967
Provider Business Practice Location Address
First Line : 125 COOL SPRINGS BLVD STE 270
Second Line :
City : FRANKLIN
State : TN
Zip : 37067-6574
Country : US
Telephone Number : 615-549-5506
Fax Number : 615-647-0748
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2007
Last Update Date : 05/03/2020

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