Basic Information
| Provider Information | |||||||||
| NPI: | 1437727708 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARDILA | ||||||||
| FirstName: | GRACE | ||||||||
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| Credential: | MSW, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3196 KENNEDY BLVD | ||||||||
| Address2: | |||||||||
| City: | UNION CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070872436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086423278 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3196 JOHN F. KENNEDY BLVD. | ||||||||
| Address2: | |||||||||
| City: | UNION CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5512403500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2021 | ||||||||
| LastUpdateDate: | 02/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 44SL06609800 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.