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General NPI Number Information
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NPI Number | 1891183547
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Entity Type | Organization
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Legal Business Name | GRACE PESIKEY INC.
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 01/05/2015
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Provider Practice Location Address
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Address Line | 19639 PLANTATIONS RD.
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-9999
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Country | US
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Telephone | 302-381-6648
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Fax |
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Provider Business Mailing Address
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Address Line | 32140 OAK DRIVE
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City | LEWES
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State | DE
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Zip | 19958-3663
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Country | US
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Telephone | 302-381-6648
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | GRACE A. PESIKEY
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Credential | LCSW/CADC
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Telephone | 302-381-6648
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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 | Q1-0000149
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License Number State | DE
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