Provider Demographics
NPI:1609076017
Name:GRENIER, KATHLEEN PATRICA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:PATRICA
Last Name:GRENIER
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 1:4602 MARTINIQUE WAY
Mailing Address - Street 2:APT. B3
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1493
Mailing Address - Country:US
Mailing Address - Phone:954-977-3187
Mailing Address - Fax:854-977-3187
Practice Address - Street 1:4602 MARTINIQUE WAY
Practice Address - Street 2:APT. B3
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-1493
Practice Address - Country:US
Practice Address - Phone:954-977-3187
Practice Address - Fax:854-977-3187
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0432521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY043252OtherLICENCE