Provider Demographics
NPI:1902528029
Name:GRZYBOWSKI, SANDRA (LICSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GRZYBOWSKI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SPRUCE ST APT 204
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-1911
Mailing Address - Country:US
Mailing Address - Phone:563-468-9314
Mailing Address - Fax:
Practice Address - Street 1:18 SPRUCE ST APT 204
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-1911
Practice Address - Country:US
Practice Address - Phone:563-468-9314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1255421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical