Healthcare Provider Details

I. General information

NPI: 1699463893
Provider Name (Legal Business Name): GRACE TURSO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HOLMES AVE
WATERBURY CT
06710-2412
US

IV. Provider business mailing address

975 MIX AVE APT 2KE
HAMDEN CT
06514-5155
US

V. Phone/Fax

Practice location:
  • Phone: 203-755-2868
  • Fax:
Mailing address:
  • Phone: 201-961-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5508
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: