Provider Demographics
NPI:1740288422
Name:GRACE, RONALD THOMAS (LCSW)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:THOMAS
Last Name:GRACE
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 1:71 MCARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-1317
Mailing Address - Country:US
Mailing Address - Phone:917-991-5272
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY STE 304
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8154
Practice Address - Country:US
Practice Address - Phone:191-799-1527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-045801-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNIC571Medicare ID - Type UnspecifiedPROVIDER NUMBER