Provider Demographics
NPI:1235149295
Name:GRACA, JOSEPH JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:GRACA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1667 48 MAIN ST.
Mailing Address - Street 2:SUITE 15
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-1805
Mailing Address - Country:US
Mailing Address - Phone:520-249-0352
Mailing Address - Fax:
Practice Address - Street 1:48 MAIN STREET
Practice Address - Street 2:SUITE 15
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-1805
Practice Address - Country:US
Practice Address - Phone:520-249-0352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical