Provider Demographics
NPI:1932479615
Name:GRUDZINSKI, ALAISA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALAISA
Middle Name:
Last Name:GRUDZINSKI
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 1:591 STEWART AVE STE 175
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4773
Mailing Address - Country:US
Mailing Address - Phone:516-302-6207
Mailing Address - Fax:
Practice Address - Street 1:591 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4763
Practice Address - Country:US
Practice Address - Phone:516-302-6207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000770611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical