Nicole E. Grace, LCSW, Psya, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

NICOLE E. GRACE, LCSW, PSYA, LLC

Practice address

14-25 Plaza Rd
Suite N 2-4
Fair Lawn, NJ 07410-3546

Phone

(201) 803-9193

NPI assigned

Jan 20, 2012

Last updated

Feb 15, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Nicole Edward Grace, LCSW, PSYANPI 1164526620

Title

Owner

Phone

(201) 803-9193

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicole E. Grace, LCSW, PSYA

  • Clinical Social Worker
  • Fair Lawn, NJ
  • NPI 1164526620
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1327017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329264000000",
    "number": "1801167085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14-25 PLAZA RD",
            "address_2": "SUITE N 2-4",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103546",
            "telephone_number": "201-803-9193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14-25 PLAZA RD",
            "address_2": "SUITE N 2-4",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103546",
            "telephone_number": "201-803-9193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLE E. GRACE, LCSW, PSYA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-20",
        "last_updated": "2012-02-15",
        "status": "A",
        "authorized_official_last_name": "GRACE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-803-9193",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW, PSYA"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Fair Lawn, NJ
• Providers in Fair Lawn, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.