| Debra Gruda Lcsw Pc | |
|
475 E Main St Suite 211 Patchogue NY 11772-3121 | |
| (516) 729-1530 | |
| Not Available |
| Full Name | Debra Gruda Lcsw Pc |
|---|---|
| Speciality | Social Worker |
| Location | 475 E Main St, Patchogue, New York |
| Authorized Official Name and Position | Debra Gruda (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 5167291530 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Debra Gruda Lcsw Pc Po Box 732 Massapequa Park NY 11762-0732 Ph: (516) 729-1530 | Debra Gruda Lcsw Pc 475 E Main St Suite 211 Patchogue NY 11772-3121 Ph: (516) 729-1530 |
| NPI Number | 1811343049 |
|---|---|
| Provider Enumeration Date | 05/06/2016 |
| Last Update Date | 05/06/2016 |
| Medicare PECOS PAC ID | 9739478629 |
|---|---|
| Medicare Enrollment ID | O20160517000025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811343049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Debra L Gruda |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649458548 PECOS PAC ID: 7911206180 Enrollment ID: I20160517000088 |
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