Active NPI
David Grand, L.C.S.W.
- Clinical Social Worker
- Bellmore, NY
National Provider Identifier
1285972075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- PRO17990-1
- Practice address
- 2415 Jerusalem Ave
Suite 105
Bellmore, NY 11710 - Phone
- (516) 785-0460
- Fax
- (516) 799-7625
- NPI assigned
- Jan 29, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | PRO17990-1 | NY | Primary |
Addresses
Primary practice location
2415 Jerusalem Ave
Suite 105
Bellmore, NY 11710
Mailing address
2415 Jerusalem Ave
Suite 105
Bellmore, NY 11710
Phone (516) 785-0460
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2018 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PRO17990-1 | NY | MD | Clinical Social Worker |
| 017990 | NY | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359417600000",
"number": "1285972075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2415 JERUSALEM AVE",
"address_2": "SUITE 105",
"city": "BELLMORE",
"state": "NY",
"postal_code": "11710",
"telephone_number": "516-785-0460",
"fax_number": "516-799-7625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2415 JERUSALEM AVE",
"address_2": "SUITE 105",
"city": "BELLMORE",
"state": "NY",
"postal_code": "11710",
"telephone_number": "516-785-0460",
"fax_number": "516-799-7625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAND",
"first_name": "DAVID",
"name_prefix": "Mr.",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-01-29",
"last_updated": "2013-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "PRO17990-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellmore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.