Provider Demographics
NPI:1336828102
Name:GRUCA, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GRUCA
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 1:15 FOSSA TER APT 2
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5133
Mailing Address - Country:US
Mailing Address - Phone:973-432-9050
Mailing Address - Fax:
Practice Address - Street 1:142 CANAL ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4673
Practice Address - Country:US
Practice Address - Phone:978-548-6288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health