Provider Demographics
NPI:1669594123
Name:GRACE, KATHLEEN (LCSW-R)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:GRACE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW-R
Mailing Address - Street 1:3201 ROUTE 212
Mailing Address - Street 2:PO BOX 44
Mailing Address - City:SPRINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18081
Mailing Address - Country:US
Mailing Address - Phone:973-650-4517
Mailing Address - Fax:
Practice Address - Street 1:3201 ROUTE 212
Practice Address - Street 2:
Practice Address - City:SPRINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:18081
Practice Address - Country:US
Practice Address - Phone:973-650-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR060166-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical