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General NPI Number Information
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NPI Number | 1093352247
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Entity Type | Organization
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Legal Business Name | GRACELI LLC
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Dates
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Enumeration Date | 12/06/2019
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 529 SEVEN BRIDGE RD UNIT 207
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-7608
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Country | US
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Telephone | 570-431-3081
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Fax |
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Provider Business Mailing Address
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Address Line | 6624 TIMOTHY LAKE RD
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City | EAST STROUDSBURG
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State | PA
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Zip | 18302-8686
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Country | US
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Telephone | 516-305-7659
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Fax |
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Authorized Official
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Title or Position | THERAPIST/CEO
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Name | MRS. LOURNA ANGELIKA CHARLES
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Credential | LCSW
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Telephone | 516-305-7659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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