Provider Demographics
NPI:1770914392
Name:GRASSL, COREY ANNE (PSYD)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:ANNE
Last Name:GRASSL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 CHIPPENDALE CIR
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9413
Mailing Address - Country:US
Mailing Address - Phone:732-770-3586
Mailing Address - Fax:
Practice Address - Street 1:8510 CHIPPENDALE CIR
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9413
Practice Address - Country:US
Practice Address - Phone:315-682-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-07
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019946103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical