Provider Demographics
NPI:1003335738
Name:NEVINS, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:NEVINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 EMERSON ST # 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3228
Mailing Address - Country:US
Mailing Address - Phone:207-776-0428
Mailing Address - Fax:
Practice Address - Street 1:207 GANNETT DR # 3
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6910
Practice Address - Country:US
Practice Address - Phone:207-536-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical