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General NPI Number Information
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NPI Number | 1922048180
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Entity Type | Individual
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Provider Name | GRACE I. CLARK-BURCH LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 4711 TRANSIT RD SUITE 3 FORESTREAM VILLAGE
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City | DEPEW
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State | NY
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Zip | 14043-4888
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Country | US
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Telephone | 716-706-5921
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Fax | 716-706-5923
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Provider Business Mailing Address
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Address Line | 247 EAST AVE
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City | LOCKPORT
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State | NY
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Zip | 14094-3825
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Country | US
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Telephone | 716-393-2905
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Fax | 716-433-0100
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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 | R076093-1
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License Number State | NY
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