Provider Demographics
NPI:1982769816
Name:GRALNICK, LORI N (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:N
Last Name:GRALNICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 VILLANOVA CT
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-1634
Mailing Address - Country:US
Mailing Address - Phone:631-849-1853
Mailing Address - Fax:347-234-5922
Practice Address - Street 1:22 VILLANOVA CT
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-1634
Practice Address - Country:US
Practice Address - Phone:631-849-1853
Practice Address - Fax:347-234-5922
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026306-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7402652OtherGHI
NY146720OtherVALUE OPTIONS
NY146720OtherVALUE OPTIONS