Provider Demographics
NPI:1760705214
Name:ASTACIO, GRACE (PSYD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:ASTACIO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 10073
Mailing Address - Street 2:CUH STATION
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792
Mailing Address - Country:US
Mailing Address - Phone:787-487-1302
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 6205
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-9503
Practice Address - Country:US
Practice Address - Phone:787-487-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3502103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical