Healthcare Provider Details

I. General information

NPI: 1508164716
Provider Name (Legal Business Name): MRS. JESSICA LUCILLE GRAMMATIKAKIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MAIN ST
WORCESTER MA
01608-1604
US

IV. Provider business mailing address

350 GOLD STAR
WORCESTER MA
01609-2668
US

V. Phone/Fax

Practice location:
  • Phone: 508-791-4976
  • Fax:
Mailing address:
  • Phone: 774-253-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: