Provider Demographics
NPI:1952570665
Name:GRADY, ALICIA BETH (LSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:BETH
Last Name:GRADY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 MISSOURI AVE
Mailing Address - Street 2:BEHAVIORAL HEALTH ONE NORTH OFFICE 1922
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3725
Mailing Address - Country:US
Mailing Address - Phone:812-283-2708
Mailing Address - Fax:812-283-2714
Practice Address - Street 1:1220 MISSOURI AVE
Practice Address - Street 2:BEHAVIORAL HEALTH ONE NORTH OFFICE 1922
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3725
Practice Address - Country:US
Practice Address - Phone:812-283-2708
Practice Address - Fax:812-283-2714
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33005298A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical