Provider Demographics
NPI:1811778640
Name:GRAGLIA, THOMAS (MSW, LSW)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GRAGLIA
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BERGEN ST # 7100
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2425
Mailing Address - Country:US
Mailing Address - Phone:973-972-9788
Mailing Address - Fax:973-972-0164
Practice Address - Street 1:90 BERGEN ST # 7100
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-9788
Practice Address - Fax:973-972-0164
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06938900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker