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General NPI Number Information
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NPI Number | 1881056125
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Entity Type | Individual
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Provider Name | RYAN GRACE MHC
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Gender | Male
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 26 COURT ST
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City | BROOKLYN
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State | NY
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Zip | 11242-0103
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Country | US
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Telephone | 929-373-3564
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Fax |
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Provider Business Mailing Address
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Address Line | 3215 CLARENDON RD APT 1R
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City | BROOKLYN
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State | NY
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Zip | 11226-6498
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Country | US
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Telephone | 404-918-1998
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 009223
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License Number State | NY
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