Healthcare Provider Details

I. General information

NPI: 1568006997
Provider Name (Legal Business Name): EMILY ROSE GRZELAK MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 FORUM PL STE 7
WEST PALM BEACH FL
33401-2330
US

IV. Provider business mailing address

449 JENNINGS AVE
GREENACRES FL
33463-2025
US

V. Phone/Fax

Practice location:
  • Phone: 561-721-8821
  • Fax:
Mailing address:
  • Phone: 413-237-2646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: