Provider Demographics
NPI:1336292234
Name:PRZYBYLSKA CONROY, GRACE (PHD LCSW)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:
Last Name:PRZYBYLSKA CONROY
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W END AVE
Mailing Address - Street 2:#1G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5503
Mailing Address - Country:US
Mailing Address - Phone:212-787-5555
Mailing Address - Fax:212-529-1163
Practice Address - Street 1:165 W END AVE
Practice Address - Street 2:#1G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5503
Practice Address - Country:US
Practice Address - Phone:212-787-5555
Practice Address - Fax:212-529-1163
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05039811041C0700X
NJ44SC048885001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY226920OtherMHN
NY483340OtherVALUE OPTIONS
NYP3264375OtherOXFORD
NY249318OtherCOMPSYCH
NY5504567OtherAETNA
NY025789OtherVMC
NYN1K823OtherBCS EMPIRE
NY7337681OtherGHI
NYN1K823OtherBCS EMPIRE