Provider Demographics
NPI:1932129772
Name:GRACE, GLORIA JEAN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:JEAN
Last Name:GRACE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:GLORIA
Other - Middle Name:GONZALES
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:607 SONOMA ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1907
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-617-2660
Practice Address - Street 1:795 WILLOW ROAD
Practice Address - Street 2:(352/117)
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-617-2660
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 63581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical