Provider Demographics
NPI:1043792526
Name:HARRIET MARI GRANDE
Entity Type:Organization
Organization Name:HARRIET MARI GRANDE
Other - Org Name:MARI GRANDE, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HARRIET
Authorized Official - Middle Name:MARI
Authorized Official - Last Name:GRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAT
Authorized Official - Phone:212-871-6856
Mailing Address - Street 1:555 KAPPOCK ST APT 26A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6434
Mailing Address - Country:US
Mailing Address - Phone:917-535-7576
Mailing Address - Fax:615-858-7576
Practice Address - Street 1:295 MADISON AVE FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6379
Practice Address - Country:US
Practice Address - Phone:212-871-6856
Practice Address - Fax:615-858-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR730767401041C0700X
NY05000197221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty