Healthcare Provider Details

I. General information

NPI: 1295245264
Provider Name (Legal Business Name): GRACE ANN BARKHO MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 VALLEY HEALTH PLZ
PARAMUS NJ
07652-3607
US

IV. Provider business mailing address

610 VALLEY HEALTH PLZ
PARAMUS NJ
07652-3607
US

V. Phone/Fax

Practice location:
  • Phone: 201-986-5037
  • Fax: 201-265-5027
Mailing address:
  • Phone: 807-986-5037
  • Fax: 801-265-5027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: