Provider Demographics
NPI:1194004168
Name:GRADY, ANYCIA M R (MSSA, LISW-S)
Entity type:Individual
Prefix:
First Name:ANYCIA
Middle Name:M R
Last Name:GRADY
Suffix:
Gender:F
Credentials:MSSA, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2325
Mailing Address - Country:US
Mailing Address - Phone:216-832-2366
Mailing Address - Fax:
Practice Address - Street 1:6303 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-2325
Practice Address - Country:US
Practice Address - Phone:216-832-2366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1700114-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical