Provider Demographics
NPI:1083697049
Name:GROSVENOR, LUCY A (LICSW)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:A
Last Name:GROSVENOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PRINCETON ST
Mailing Address - Street 2:SUITE203
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1558
Mailing Address - Country:US
Mailing Address - Phone:978-256-6579
Mailing Address - Fax:978-256-1943
Practice Address - Street 1:73 PRINCETON ST
Practice Address - Street 2:SUITE203
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1558
Practice Address - Country:US
Practice Address - Phone:978-256-6579
Practice Address - Fax:978-256-1943
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1409328Y0MA01OtherBCBSNH
MA162104000OtherMAGELLAN
MA103090OtherTUFTS
MA043476807-02OtherPACIFICARE
MA103090OtherSECURE HORIZON
MA009143OtherVALUE OPTIONS
MA800009597OtherRAILROAD MEDICARE
MA0022320OtherNHP
MA1858335Medicaid
MA333110OtherMHN
MAP02227OtherBCBSMA
MA971702OtherNETWORK HEALTH
MAP02227Medicare ID - Type Unspecified