Provider Demographics
NPI:1194016089
Name:DEMANE, GRACE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:DEMANE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WOODROW ROAD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1978
Mailing Address - Country:US
Mailing Address - Phone:718-356-0008
Mailing Address - Fax:718-356-6566
Practice Address - Street 1:80 WOODROW ROAD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1978
Practice Address - Country:US
Practice Address - Phone:718-356-0008
Practice Address - Fax:718-356-6566
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027882-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical