Provider Demographics
NPI:1629785738
Name:TROTMAN, GRACIE (MA)
Entity Type:Individual
Prefix:MS
First Name:GRACIE
Middle Name:
Last Name:TROTMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 RALDNE RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1213
Mailing Address - Country:US
Mailing Address - Phone:857-205-3128
Mailing Address - Fax:
Practice Address - Street 1:1354 HANCOCK ST STE 212
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5134
Practice Address - Country:US
Practice Address - Phone:617-471-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health