Provider Demographics
NPI:1922646041
Name:BRACEY, JOSI LATROY (MSW)
Entity Type:Individual
Prefix:MS
First Name:JOSI
Middle Name:LATROY
Last Name:BRACEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S GRAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4434
Mailing Address - Country:US
Mailing Address - Phone:714-480-6467
Mailing Address - Fax:
Practice Address - Street 1:1300 S. GRAND
Practice Address - Street 2:BLDG B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-480-6476
Practice Address - Fax:714-567-7566
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1112761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty