Healthcare Provider Details

I. General information

NPI: 1093028144
Provider Name (Legal Business Name): DENISE YVONNE GRACE-SINGLETON BA, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 AMORY ST
JAMAICA PLAIN MA
02130-2310
US

IV. Provider business mailing address

304 AMORY ST
JAMAICA PLAIN MA
02130-2310
US

V. Phone/Fax

Practice location:
  • Phone: 617-921-4359
  • Fax: 617-524-2809
Mailing address:
  • Phone: 617-921-4359
  • Fax: 617-524-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number272420125
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: