Provider Demographics
NPI:1093352247
Name:GRACELI LLC
Entity Type:Organization
Organization Name:GRACELI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOURNA
Authorized Official - Middle Name:ANGELIKA
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-305-7659
Mailing Address - Street 1:6624 TIMOTHY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18302-8686
Mailing Address - Country:US
Mailing Address - Phone:516-305-7659
Mailing Address - Fax:
Practice Address - Street 1:529 SEVEN BRIDGE RD UNIT 207
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7608
Practice Address - Country:US
Practice Address - Phone:570-431-3081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty