Provider Demographics
NPI:1407164494
Name:CLEVES, GRACIELA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:CLEVES
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5517 PACIFIC BLVD APT 4409
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-6719
Mailing Address - Country:US
Mailing Address - Phone:954-695-5918
Mailing Address - Fax:
Practice Address - Street 1:199 W PALMETTO PARK RD STE 6
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3809
Practice Address - Country:US
Practice Address - Phone:561-393-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2507106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist