Provider Demographics
NPI:1487034492
Name:GRUNBERG, ALENA LYGATE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALENA
Middle Name:LYGATE
Last Name:GRUNBERG
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 1:580 5TH AVE STE 820
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4762
Mailing Address - Country:US
Mailing Address - Phone:929-277-0772
Mailing Address - Fax:
Practice Address - Street 1:580 5TH AVE STE 820
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4762
Practice Address - Country:US
Practice Address - Phone:929-277-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092208106H00000X, 1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT854233153OtherLLC