Provider Demographics
NPI:1730276627
Name:OWEN, GRACE (LCSW)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:OWEN
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 1:1158 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4737
Mailing Address - Country:US
Mailing Address - Phone:718-451-0457
Mailing Address - Fax:
Practice Address - Street 1:124 UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2339
Practice Address - Country:US
Practice Address - Phone:718-771-3136
Practice Address - Fax:718-773-4273
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0504511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical