=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609281542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUMANA MARIE GRASSI LCSW, CASAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2014
-----------------------------------------------------
Last Update Date | 08/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 PURCHASE ST # 335
-----------------------------------------------------
City | RYE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10580-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-512-2236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 PURCHASE ST # 335
-----------------------------------------------------
City | RYE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10580-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-512-2236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 084383
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------