Provider Demographics
NPI:1053697334
Name:PARK, GRACE EUNHAE (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:EUNHAE
Last Name:PARK
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 GARRISON BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216
Mailing Address - Country:US
Mailing Address - Phone:410-233-6200
Mailing Address - Fax:
Practice Address - Street 1:2300 GARRISON BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216
Practice Address - Country:US
Practice Address - Phone:410-233-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG12925104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker