Healthcare Provider Details

I. General information

NPI: 1700083805
Provider Name (Legal Business Name): NOEL GRAZIANI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FLATBUSH AVE
BROOKLYN NY
11217-2812
US

IV. Provider business mailing address

420 E 55TH ST APT 10K
NEW YORK NY
10022-5143
US

V. Phone/Fax

Practice location:
  • Phone: 718-622-2000
  • Fax: 718-398-3328
Mailing address:
  • Phone: 212-962-7817
  • Fax: 212-227-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number046662-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: