Provider Demographics
NPI:1205309283
Name:ADAMS, GRACIELA G
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:G
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 OAKS CLUBHOUSE DR APT 204
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3629
Mailing Address - Country:US
Mailing Address - Phone:561-376-9022
Mailing Address - Fax:
Practice Address - Street 1:951 BROKEN SOUND PKWY NW STE 350
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-3531
Practice Address - Country:US
Practice Address - Phone:561-465-5537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-13508106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty