Provider Demographics
NPI:1316576515
Name:GRAZIANO THERAPY, INDIVIDUAL AND MARRIAGE COUNSELING, PC
Entity Type:Organization
Organization Name:GRAZIANO THERAPY, INDIVIDUAL AND MARRIAGE COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:N
Authorized Official - Last Name:GRAZIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:323-717-9897
Mailing Address - Street 1:4613 ALABAMA ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2705
Mailing Address - Country:US
Mailing Address - Phone:323-717-9897
Mailing Address - Fax:
Practice Address - Street 1:3333 CAMINO DEL RIO S STE 215
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3837
Practice Address - Country:US
Practice Address - Phone:323-717-9897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health