Provider Demographics
NPI:1992162184
Name:O'SHAUGHNESSY, GRACE (LMSW)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:O'SHAUGHNESSY
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 1:60 MADISON AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2439
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:94-98 MANHATTAN AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2505
Practice Address - Country:US
Practice Address - Phone:718-388-0390
Practice Address - Fax:718-486-5741
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088736104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000695941Medicaid
NY331945Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331952Medicare Oscar/Certification
NY000695941Medicaid
NY331058Medicare Oscar/Certification
OH331954Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NY331944Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NY331946Medicare Oscar/Certification