Healthcare Provider Details

I. General information

NPI: 1922918507
Provider Name (Legal Business Name): GRACE RACICOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 NY-22B
MORRISONVILLE NY
12962
US

IV. Provider business mailing address

25 DRAPER AVE
PLATTSBURGH NY
12901-2605
US

V. Phone/Fax

Practice location:
  • Phone: 518-563-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: