Provider Demographics
NPI:1417648056
Name:DIEVENEY, GRACE KATHLEEN (RBT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:KATHLEEN
Last Name:DIEVENEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8151 SOUTHPARK LN UNIT 100
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4502
Mailing Address - Country:US
Mailing Address - Phone:720-617-1581
Mailing Address - Fax:
Practice Address - Street 1:8151 SOUTHPARK LN UNIT 100
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4502
Practice Address - Country:US
Practice Address - Phone:720-617-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-23-273465106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician