Healthcare Provider Details

I. General information

NPI: 1659166544
Provider Name (Legal Business Name): GRACIELA EMMA LEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FEDERAL BLVD
DENVER CO
80204-3219
US

IV. Provider business mailing address

187 MUSCOVEY LN
JOHNSTOWN CO
80534-4613
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-4200
  • Fax:
Mailing address:
  • Phone: 720-390-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: