Provider Demographics
NPI:1023235959
Name:GROCHOW, CARRIE J
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:J
Last Name:GROCHOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 71ST ST
Mailing Address - Street 2:APT. 12B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 E 71ST ST
Practice Address - Street 2:APT. 12B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4808
Practice Address - Country:US
Practice Address - Phone:516-695-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-004010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health