Provider Demographics
NPI:1205491545
Name:GRELLA, CANDICE ELIZABETH (LMHC)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:ELIZABETH
Last Name:GRELLA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:ELIZABETH
Other - Last Name:WERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-0142
Mailing Address - Country:US
Mailing Address - Phone:914-441-8199
Mailing Address - Fax:
Practice Address - Street 1:30 E 60TH ST RM 208
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-7135
Practice Address - Country:US
Practice Address - Phone:212-847-0144
Practice Address - Fax:212-847-0144
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001887208D00000X, 101YM0800X
NY101YS0200X, 103K00000X, 106S00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001887OtherNYS OFFICE OF THE PROFESSIONS LMHC