Provider Demographics
NPI:1518187517
Name:PHILLIPS, GRISELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GRISELLE
Middle Name:
Last Name:PHILLIPS
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 1:1010 SHERMAN AVE
Mailing Address - Street 2:APT. 1H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-6122
Mailing Address - Country:US
Mailing Address - Phone:718-410-9433
Mailing Address - Fax:
Practice Address - Street 1:44 WESTCHESTER SQ
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3526
Practice Address - Country:US
Practice Address - Phone:718-409-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP065098-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1072820OtherPROVIDER IDENTIFICATION