Provider Demographics
NPI:1225865520
Name:GRACE, ASHLEY RYAN (LMSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RYAN
Last Name:GRACE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3052
Mailing Address - Country:US
Mailing Address - Phone:203-450-2201
Mailing Address - Fax:
Practice Address - Street 1:10 ELMWOOD RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-3052
Practice Address - Country:US
Practice Address - Phone:203-450-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8039104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker