Provider Demographics
NPI:1255442422
Name:SEIBERT-LARKE, GRACE (PSYD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:SEIBERT-LARKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-3115
Mailing Address - Country:US
Mailing Address - Phone:781-834-0390
Mailing Address - Fax:781-837-3111
Practice Address - Street 1:2016 OCEAN ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-3115
Practice Address - Country:US
Practice Address - Phone:781-834-0390
Practice Address - Fax:781-837-3111
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY 6862-PR103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW 50745Medicare ID - Type Unspecified