Provider Demographics
NPI:1093386559
Name:GRASMICK, MARY S (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:GRASMICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1981 E PALMER WASILLA HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7287
Mailing Address - Country:US
Mailing Address - Phone:907-802-2493
Mailing Address - Fax:
Practice Address - Street 1:1981 E PALMER WASILLA HWY STE 200
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7287
Practice Address - Country:US
Practice Address - Phone:907-802-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL104671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL10467OtherLCSW LICENSE