Provider Demographics
NPI:1356662563
Name:GRANDISON, PATRICIA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:GRANDISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W 82ND ST
Mailing Address - Street 2:APT. 7C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5503
Mailing Address - Country:US
Mailing Address - Phone:212-799-9420
Mailing Address - Fax:
Practice Address - Street 1:127 W 82ND ST
Practice Address - Street 2:APT. 7C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5503
Practice Address - Country:US
Practice Address - Phone:212-799-9420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO34027-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool