Provider Demographics
NPI:1477856599
Name:MCGROSKY, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MCGROSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 MAIN ST
Mailing Address - Street 2:APT. # 1015
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0053
Mailing Address - Country:US
Mailing Address - Phone:212-223-3227
Mailing Address - Fax:
Practice Address - Street 1:595 MAIN ST
Practice Address - Street 2:APT. # 1015
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044-0053
Practice Address - Country:US
Practice Address - Phone:212-223-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-11
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR071169-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical