Provider Demographics
NPI:1215069810
Name:GRABOW, NANCY G (LCSW-R)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:G
Last Name:GRABOW
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:GRADY
Other - Last Name:GRABOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:168 KINSLEY ST
Mailing Address - Street 2:
Mailing Address - City:SHERRILL
Mailing Address - State:NY
Mailing Address - Zip Code:13461-1102
Mailing Address - Country:US
Mailing Address - Phone:315-363-7005
Mailing Address - Fax:
Practice Address - Street 1:168 KINSLEY ST
Practice Address - Street 2:
Practice Address - City:SHERRILL
Practice Address - State:NY
Practice Address - Zip Code:13461-1102
Practice Address - Country:US
Practice Address - Phone:315-363-7005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046143-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY151921OtherVALUE OPTIONS
NYO1917748Medicaid
NY7484006OtherGHI
NY6258154OtherUBH,UNITED HEALTHCARE
NY318830OtherMVP HEALTH PLAN
NY7484006OtherGHI