Individual provider Active NPI

Grace E Henry, LISW

  • Clinical Social Worker
  • Cincinnati, OH
National Provider Identifier
1104631977
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I.2506879 Issued in OH
Practice address
311 Albert Sabin Way
Cincinnati, OH 45229-2838
Phone
(513) 558-9067
NPI assigned
Feb 10, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I.2506879 OH Primary

Addresses

Primary practice location

311 Albert Sabin Way
Cincinnati, OH 45229-2838

Mailing address

6769 N Wickham Rd Ste B101
Melbourne, FL 32940-2048

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250227003964 FL Practitioner - Clinical Social Worker 3072033406 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I.2506879OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
M3 Haven Inc. Clinical CurrentSince Feb 1, 2025 Accepting new patients

Locations

930 S Harbor City Blvd
Ste 100
Melbourne, FL 32901
Phone (321) 321-1490

6769 N Wickham Rd
Ste B101
Melbourne, FL 32940
Phone (321) 321-1490

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1739145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1104631977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6769 N WICKHAM RD STE B101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 ALBERT SABIN WAY",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452292838",
            "telephone_number": "513-558-9067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "GRACE",
        "middle_name": "E",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-10",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2506879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.