Provider Demographics
NPI:1326364084
Name:LEGRANDE, DANA J (LCSW)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:J
Last Name:LEGRANDE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:CALIXTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW R
Mailing Address - Street 1:700 FULTON ST APT M3
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3447
Mailing Address - Country:US
Mailing Address - Phone:516-302-5645
Mailing Address - Fax:631-647-2058
Practice Address - Street 1:1444 5TH AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4147
Practice Address - Country:US
Practice Address - Phone:631-650-0143
Practice Address - Fax:631-647-2058
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0795471041C0700X
NY0808691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00079547Medicaid