Provider Demographics
NPI:1902485493
Name:TILEARCIO, GRACE ANN
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ANN
Last Name:TILEARCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CAROL DR
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-8118
Mailing Address - Country:US
Mailing Address - Phone:845-803-3727
Mailing Address - Fax:
Practice Address - Street 1:2125 ALBANY POST RD STE 305
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548-1447
Practice Address - Country:US
Practice Address - Phone:914-362-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094984104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker