Provider Demographics
NPI:1184998296
Name:THREE GRACES, LLP
Entity type:Organization
Organization Name:THREE GRACES, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUISA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, NCC
Authorized Official - Phone:860-267-2687
Mailing Address - Street 1:251 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2357
Mailing Address - Country:US
Mailing Address - Phone:860-661-1133
Mailing Address - Fax:860-469-2966
Practice Address - Street 1:251 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2357
Practice Address - Country:US
Practice Address - Phone:860-661-1133
Practice Address - Fax:860-469-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT275464Medicaid