Healthcare Provider Details

I. General information

NPI: 1255261186
Provider Name (Legal Business Name): ADELLE ELIZABETH GRAVINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CORDWAINER DR
NORWELL MA
02061-1671
US

IV. Provider business mailing address

51 STETSON SHRINE LN
NORWELL MA
02061-2608
US

V. Phone/Fax

Practice location:
  • Phone: 781-878-8340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: