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General NPI Number Information
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NPI Number | 1205491545
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Entity Type | Individual
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Provider Name | CANDICE ELIZABETH GRELLA LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 30 E 60TH ST RM 208
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City | NEW YORK
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State | NY
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Zip | 10022-7135
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Country | US
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Telephone | 212-847-0144
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Fax | 212-847-0144
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Provider Business Mailing Address
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Address Line | PO BOX 142
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City | SCARSDALE
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State | NY
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Zip | 10583-0142
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Country | US
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Telephone | 914-441-8199
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 001887
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 001887
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License Number State | NY
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