Provider Demographics
NPI:1518394634
Name:GRACIANI, JODI (OSC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:GRACIANI
Suffix:
Gender:F
Credentials:OSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BERWICK CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-8309
Mailing Address - Country:US
Mailing Address - Phone:845-827-6364
Mailing Address - Fax:
Practice Address - Street 1:2 BERWICK CIR
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-8309
Practice Address - Country:US
Practice Address - Phone:845-827-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator