Provider Demographics
NPI:1780409789
Name:GRACYALNY, KRISTEN MEREDITH (MA, CAS, NCSP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MEREDITH
Last Name:GRACYALNY
Suffix:
Gender:F
Credentials:MA, CAS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 WONDER VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3751
Mailing Address - Country:US
Mailing Address - Phone:443-243-8073
Mailing Address - Fax:
Practice Address - Street 1:850 HUNGERFORD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1718
Practice Address - Country:US
Practice Address - Phone:443-243-8073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1001640525103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool