Provider Demographics
NPI:1245762731
Name:GROWNEY, GERALD EDWARD (LCSW)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:EDWARD
Last Name:GROWNEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 W 22ND ST APT 5G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2761
Mailing Address - Country:US
Mailing Address - Phone:646-284-7644
Mailing Address - Fax:
Practice Address - Street 1:247 E 20TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1801
Practice Address - Country:US
Practice Address - Phone:646-284-7644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085436-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical