Provider Demographics
NPI:1720233703
Name:GRAZIANO, JAMES (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GRAZIANO
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SOUTH COUNTRY ROAD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713
Mailing Address - Country:US
Mailing Address - Phone:631-561-9697
Mailing Address - Fax:631-846-3485
Practice Address - Street 1:112 SOUTH COUNTRY ROAD
Practice Address - Street 2:SUITE 211
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713
Practice Address - Country:US
Practice Address - Phone:631-561-9697
Practice Address - Fax:631-846-3485
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046713-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300043028Medicare UPIN