Healthcare Provider Details

I. General information

NPI: 1245309087
Provider Name (Legal Business Name): STACEY ALLENE GRAZIANO SCHOOL PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 E LOHMAN AVE STE 213
LAS CRUCES NM
88001-3172
US

IV. Provider business mailing address

PO BOX 14003
LAS CRUCES NM
88013-4003
US

V. Phone/Fax

Practice location:
  • Phone: 801-609-8037
  • Fax:
Mailing address:
  • Phone: 801-609-8037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number319903
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9444446-2501
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1444
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: