Healthcare Provider Details

I. General information

NPI: 1952389868
Provider Name (Legal Business Name): CYNTHIA MARY GRACIANETTE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIS USNH NAPLES PSC 827 BOX 10
FPO AE
09617
IT

IV. Provider business mailing address

EDIS USNH NAPLES PSC 827 BOX 10
FPO AE
09617
IT

V. Phone/Fax

Practice location:
  • Phone: 81-811-4676
  • Fax: 81-811-4669
Mailing address:
  • Phone: 81-811-4676
  • Fax: 81-811-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number524
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number524
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: