Provider Demographics
NPI:1417348012
Name:GRANT, KARINA (LCSW)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KARINA
Other - Middle Name:
Other - Last Name:COLLADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1175 FULTON AVE
Mailing Address - Street 2:APT 2D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-4320
Mailing Address - Country:US
Mailing Address - Phone:646-488-5126
Mailing Address - Fax:
Practice Address - Street 1:21 JUMEL PL
Practice Address - Street 2:RM. A127
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4316
Practice Address - Country:US
Practice Address - Phone:212-923-1495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088963101YS0200X
NY0876641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
12121986OtherDOB