Provider Demographics
NPI:1770289027
Name:GRACIANI, ANGEL GABRIEL (CPL, MMHL)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:GABRIEL
Last Name:GRACIANI
Suffix:
Gender:M
Credentials:CPL, MMHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 2 URB. ROSA MARIA
Mailing Address - Street 2:B11
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-674-3735
Mailing Address - Fax:
Practice Address - Street 1:CALLE 2 URB. ROSA MARIA
Practice Address - Street 2:B11
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-674-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4516101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health