Provider Demographics
NPI:1215209267
Name:GRASSO, ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:GRASSO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 AVIATION RD
Mailing Address - Street 2:
Mailing Address - City:COLONIE
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1179
Mailing Address - Country:US
Mailing Address - Phone:518-438-9596
Mailing Address - Fax:518-438-9598
Practice Address - Street 1:21 AVIATION RD
Practice Address - Street 2:
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205-1179
Practice Address - Country:US
Practice Address - Phone:518-438-9596
Practice Address - Fax:518-438-9598
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPO17992104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker