Provider Demographics
NPI:1700822277
Name:GRACE, KIRSTEN E (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:E
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 1:34 SCHOOL ST STE 207
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2318
Mailing Address - Country:US
Mailing Address - Phone:508-505-7403
Mailing Address - Fax:508-608-1051
Practice Address - Street 1:34 SCHOOL ST STE 207
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2318
Practice Address - Country:US
Practice Address - Phone:508-505-7403
Practice Address - Fax:508-608-1051
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10317211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGR-P24053Medicare ID - Type Unspecified