MEDICARE: GRACE WEINSTEIN LCSWR

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	086720	NY

General Provider Information

NPI Number	:	1578965562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE WEINSTEIN LCSWR

Provider Business Mailing Address
First Line	:	PO BOX 270356
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14627-0356
Country	:	US
Telephone Number	:	914-552-6666
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 270356
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14627-0356
Country	:	US
Telephone Number	:	914-552-6666
Fax Number	:

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

Provider Enumeration Date	:	09/22/2014
Last Update Date	:	08/20/2024

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