Basic Information
| Provider Information | |||||||||
| NPI: | 1194016089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEMANE | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 WOODROW ROAD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103121978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183560008 | ||||||||
| FaxNumber: | 7183566566 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 WOODROW ROAD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103121978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183560008 | ||||||||
| FaxNumber: | 7183566566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2011 | ||||||||
| LastUpdateDate: | 05/11/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R027882-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.