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NPI Code Detail

MEDICARE: MRS. SUSAN R GRANDE LMHC

MEDICARE: MRS. SUSAN R GRANDE LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor004259NY

General Provider Information

NPI Number : 1174852651
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN R GRANDE LMHC
Provider Business Mailing Address
First Line : 2725 HARWAY AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11214-5539
Country : US
Telephone Number : 718-333-0321
Fax Number :
Provider Business Practice Location Address
First Line : 2725 HARWAY AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11214-5539
Country : US
Telephone Number : 718-333-0321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2009
Last Update Date : 12/14/2009

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Directions to “ MRS. SUSAN R GRANDE LMHC” Practice Location

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