Provider Demographics
NPI:1609977404
Name:GRONCKI, MARY ANN ALEXANDRA (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:ALEXANDRA
Last Name:GRONCKI
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MS
Other - First Name:MARY ANN
Other - Middle Name:ALEXANDRA
Other - Last Name:GRONCKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:713 04 STATE ROAD
Mailing Address - Street 2:MARY ANN GRONCKI
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312
Mailing Address - Country:US
Mailing Address - Phone:215-292-3276
Mailing Address - Fax:
Practice Address - Street 1:3 PAOLI PLAZA
Practice Address - Street 2:MARY ANN A GRONCKI MSW LCSW SUITE D
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:215-292-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014618103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2318680000OtherBCBS PERSONAL CHOICE
1000067657001OtherAPS
7902198OtherAETNA
206938OtherMHN