Provider Demographics
NPI:1063009934
Name:GRADZEWICZ, SHEENA (LICSW)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:GRADZEWICZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-7361
Mailing Address - Country:US
Mailing Address - Phone:781-854-8890
Mailing Address - Fax:978-912-9059
Practice Address - Street 1:43 EMERALD ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-7361
Practice Address - Country:US
Practice Address - Phone:781-854-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1234671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA15804151OtherCAQH