Provider Demographics
NPI:1356564199
Name:GRACE, DEBORAH F (LICSW)
Entity type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:F
Last Name:GRACE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PINE RIDGE LANE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364
Mailing Address - Country:US
Mailing Address - Phone:781-585-6896
Mailing Address - Fax:
Practice Address - Street 1:BAYVIEW ASSOCIATES
Practice Address - Street 2:64 INDUSTRIAL PARK ROAD
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:617-847-1950
Practice Address - Fax:617-774-1490
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10249191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical