Provider Demographics
NPI:1336485275
Name:GRACIA, ANGEL
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:GRACIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WEAVER CT
Mailing Address - Street 2:APT.A
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1223
Mailing Address - Country:US
Mailing Address - Phone:617-680-8879
Mailing Address - Fax:
Practice Address - Street 1:280 BRIDGE ST
Practice Address - Street 2:SUITE 230
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1759
Practice Address - Country:US
Practice Address - Phone:781-320-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator