Provider Demographics
NPI:1265188809
Name:GRACIA-ARANA, JOSE MANUEL (MCSW, JD)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MANUEL
Last Name:GRACIA-ARANA
Suffix:
Gender:M
Credentials:MCSW, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SAMUEL ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-6215
Mailing Address - Country:US
Mailing Address - Phone:939-225-0044
Mailing Address - Fax:
Practice Address - Street 1:130 SAMUEL ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-6215
Practice Address - Country:US
Practice Address - Phone:939-225-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health