Provider Demographics
NPI:1730440694
Name:GROSVENOR, JACQUELINE C (OSC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:C
Last Name:GROSVENOR
Suffix:
Gender:F
Credentials:OSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 PARKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-3809
Mailing Address - Country:US
Mailing Address - Phone:914-548-8607
Mailing Address - Fax:914-548-8607
Practice Address - Street 1:68 PARKVIEW RD
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-3809
Practice Address - Country:US
Practice Address - Phone:914-548-8607
Practice Address - Fax:914-548-8607
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator