MEDICARE: GRACE MANNIX-SLOBIG LMSW

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	104100000X	Social Worker	113682	NY

General Provider Information

NPI Number	:	1700571510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE MANNIX-SLOBIG LMSW

Provider Business Mailing Address
First Line	:	519 8TH AVENUE, 9TH FLOOR
Second Line	:	6S
City	:	NEW YORK CITY
State	:	NY
Zip	:	10018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	519 8TH AVENUE, 9TH FLOOR
Second Line	:	6S
City	:	NEW YORK CITY
State	:	NY
Zip	:	10018
Country	:	US
Telephone Number	:	917-688-4410
Fax Number	:

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

Provider Enumeration Date	:	04/07/2023
Last Update Date	:	04/07/2023

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