Provider Demographics
NPI:1588010151
Name:REAL, GRACIELA NOEMI (ASW)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:NOEMI
Last Name:REAL
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 RAMONA EXPY STE 1
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-7014
Mailing Address - Country:US
Mailing Address - Phone:951-349-4195
Mailing Address - Fax:
Practice Address - Street 1:85 RAMONA EXPY STE 1
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-7014
Practice Address - Country:US
Practice Address - Phone:951-349-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW698381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical