Provider Demographics
NPI:1871513036
Name:GROSVENOR, LUCIE D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LUCIE
Middle Name:D
Last Name:GROSVENOR
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 1:199 SAINT JOHN'S PLACE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3405
Mailing Address - Country:US
Mailing Address - Phone:718-783-6942
Mailing Address - Fax:718-783-6942
Practice Address - Street 1:199 SAINT JOHNS PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3405
Practice Address - Country:US
Practice Address - Phone:718-783-6942
Practice Address - Fax:718-783-6942
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR044974-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02454295Medicaid
NYP2738420Medicare UPIN
NYN7T501Medicare ID - Type Unspecified