Provider Demographics
NPI:1952389868
Name:GRACIANETTE, CYNTHIA MARY (PHD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:MARY
Last Name:GRACIANETTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EDIS USNH NAPLES
Mailing Address - Street 2:PSC 827 BOX 10
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09617
Mailing Address - Country:IT
Mailing Address - Phone:081-811-4676
Mailing Address - Fax:081-811-4669
Practice Address - Street 1:EDIS USNH NAPLES
Practice Address - Street 2:PSC 827 BOX 10
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09617
Practice Address - Country:IT
Practice Address - Phone:081-811-4676
Practice Address - Fax:081-811-4669
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL524103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent