Provider Demographics
NPI:1174240790
Name:HERMAN, GRACE G (LCSW)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:G
Last Name:HERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:G
Other - Last Name:HERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:53 SKIPPER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2732
Mailing Address - Country:US
Mailing Address - Phone:860-877-5889
Mailing Address - Fax:
Practice Address - Street 1:73 CEDAR ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1301
Practice Address - Country:US
Practice Address - Phone:860-224-5267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0121591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical