Provider Demographics
NPI:1275268211
Name:CHO, GRACE (RCSWI)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 SHADY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6205
Mailing Address - Country:US
Mailing Address - Phone:954-547-9928
Mailing Address - Fax:754-400-9113
Practice Address - Street 1:6201 SW180TH TERRACE
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33331
Practice Address - Country:US
Practice Address - Phone:954-547-9928
Practice Address - Fax:754-400-9113
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16484104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker