MEDICARE: MS. GRACE PRZYBYLSKA CONROY PH.D. LCSW

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
1	1041C0700X	Clinical Social Worker	R0503981	NY
2	1041C0700X	Clinical Social Worker	44SC04888500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	226920	OTHER	NY	MHN
2	483340	OTHER	NY	VALUE OPTIONS
3	P3264375	OTHER	NY	OXFORD
4	249318	OTHER	NY	COMPSYCH
5	5504567	OTHER	NY	AETNA
6	025789	OTHER	NY	VMC
7	N1K823	OTHER	NY	BCS EMPIRE
8	7337681	OTHER	NY	GHI

General Provider Information

NPI Number	:	1336292234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GRACE PRZYBYLSKA CONROY PH.D. LCSW

Provider Business Mailing Address
First Line	:	165 W END AVE
Second Line	:	#1G
City	:	NEW YORK
State	:	NY
Zip	:	10023-5503
Country	:	US
Telephone Number	:	212-787-5555
Fax Number	:	212-529-1163

Provider Business Practice Location Address
First Line	:	165 W END AVE
Second Line	:	#1G
City	:	NEW YORK
State	:	NY
Zip	:	10023-5503
Country	:	US
Telephone Number	:	212-787-5555
Fax Number	:	212-529-1163

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	03/19/2010

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