Provider Demographics
NPI:1467507111
Name:GROVER, MARY F (LCSW R ACSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:F
Last Name:GROVER
Suffix:
Gender:F
Credentials:LCSW R ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209
Mailing Address - Country:US
Mailing Address - Phone:716-881-2405
Mailing Address - Fax:716-881-2425
Practice Address - Street 1:1487 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209
Practice Address - Country:US
Practice Address - Phone:716-881-2405
Practice Address - Fax:716-881-2425
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02633211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00357855Medicaid