Provider Demographics
NPI:1679891246
Name:GRACE, VICTORIA (LICSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GRACE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COMPASS WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1466
Mailing Address - Country:US
Mailing Address - Phone:508-350-2225
Mailing Address - Fax:508-350-2229
Practice Address - Street 1:1 COMPASS WAY STE 106
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1466
Practice Address - Country:US
Practice Address - Phone:508-350-2225
Practice Address - Fax:508-350-2229
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1138301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical