Provider Demographics
NPI:1902855018
Name:LADELFA, GRACELYN T (LMT, NCTMB)
Entity Type:Individual
Prefix:MS
First Name:GRACELYN
Middle Name:T
Last Name:LADELFA
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CROSMAN TER
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1827
Mailing Address - Country:US
Mailing Address - Phone:585-473-6447
Mailing Address - Fax:
Practice Address - Street 1:39 N GOODMAN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1501
Practice Address - Country:US
Practice Address - Phone:585-764-4325
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012708-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist