=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821237868
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSETTE L GRADY LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2009
-----------------------------------------------------
Last Update Date | 05/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 E SCHUYLKILL RD APT 124
-----------------------------------------------------
City | POTTSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19465-7593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-447-6920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 E SCHUYLKILL RD APT 124
-----------------------------------------------------
City | POTTSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19465-7593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-447-6920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW016361
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------