Provider Demographics
NPI:1568174977
Name:GRACIA, JACQUELINE (MSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:GRACIA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1028
Mailing Address - Country:US
Mailing Address - Phone:516-395-0840
Mailing Address - Fax:
Practice Address - Street 1:338 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1028
Practice Address - Country:US
Practice Address - Phone:516-395-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty