Basic Information
| Provider Information | |||||||||
| NPI: | 1578965562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEINSTEIN | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 837 CHARLES POND DR | ||||||||
| Address2: | |||||||||
| City: | CORAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117273753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9145526666 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1444 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | BAY SHORE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117064147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316473100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2014 | ||||||||
| LastUpdateDate: | 09/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 093068 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.