Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 001887 | NY |
N | 101YS0200X | School Counselor | NY | |
N | 103K00000X | Behavior Analyst | NY | |
N | 106S00000X | Behavior Technician | NY | |
N | 208D00000X | General Practice Physician | 001887 | NY |
NPI | 1205491545 |
---|---|
Provider Name | Candice Elizabeth Grella |
First Address | Scarsdale, NY 10583-0142 |
Second Address | New York, NY 10022-7135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2019 |
Last Update Date | 02/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001887 | NYS OFFICE OF THE PROFESSIONS LMHC (01) | NY |