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General NPI Number Information
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NPI Number | 1740288422
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Entity Type | Individual
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Provider Name | RONALD THOMAS GRACE LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 928 BROADWAY STE 304
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City | NEW YORK
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State | NY
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Zip | 10010-8154
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Country | US
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Telephone | 191-799-1527
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Fax |
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Provider Business Mailing Address
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Address Line | 71 MCARTHUR AVE
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City | TUCKAHOE
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State | NY
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Zip | 10707-1317
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Country | US
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Telephone | 917-991-5272
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R-045801-1
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License Number State | NY
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