Healthcare Provider Details

I. General information

NPI: 1043792526
Provider Name (Legal Business Name): HARRIET MARI GRANDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 MADISON AVE FL 12
NEW YORK NY
10017-6379
US

IV. Provider business mailing address

555 KAPPOCK ST APT 26A
BRONX NY
10463-6434
US

V. Phone/Fax

Practice location:
  • Phone: 212-871-6856
  • Fax: 615-858-7576
Mailing address:
  • Phone: 917-535-7576
  • Fax: 615-858-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR73076740
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number05000197
License Number StateNY

VIII. Authorized Official

Name: HARRIET MARI GRANDE
Title or Position: PSYCHOTHERAPIST
Credential: LCSW, LCAT
Phone: 212-871-6856