Healthcare Provider Details

I. General information

NPI: 1720805369
Provider Name (Legal Business Name): GRACEN REED LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PINE AVE STE 609
LONG BEACH CA
90802-2310
US

IV. Provider business mailing address

130 S SEPULVEDA BLVD UNIT 407
LOS ANGELES CA
90049-3155
US

V. Phone/Fax

Practice location:
  • Phone: 310-571-5041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number140886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: