Healthcare Provider Details

I. General information

NPI: 1104599216
Provider Name (Legal Business Name): GRACE MCCLEARY WILLIAMS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 SAINT MARKS PL
NEW YORK NY
10003-7902
US

IV. Provider business mailing address

661 LINCOLN PL APT 7I
BROOKLYN NY
11216-5478
US

V. Phone/Fax

Practice location:
  • Phone: 212-982-3470
  • Fax:
Mailing address:
  • Phone: 626-390-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113030-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: