Provider Demographics
NPI:1649234964
Name:PUCHALSKI, GRACE (LCSW-)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:
Last Name:PUCHALSKI
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 1:203 SUNFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5646
Mailing Address - Country:US
Mailing Address - Phone:315-278-4523
Mailing Address - Fax:
Practice Address - Street 1:913 OLD LIVERPOOL RD
Practice Address - Street 2:SUITE K
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5757
Practice Address - Country:US
Practice Address - Phone:315-278-4523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0468621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336519172OtherNPI - WALK WITH GRACE
NYR046862OtherNYS DEPT. OF EDUCATION
NYR046862OtherNYS DEPT. OF EDUCATION