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NPI Code Detail

MEDICARE: SHEILA T. GRACE M.S.W.

MEDICARE: SHEILA T. GRACE M.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker863ME

General Provider Information

NPI Number : 1215095484
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHEILA T. GRACE M.S.W.
Provider Business Mailing Address
First Line : 345 COTTAGE RD
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-3919
Country : US
Telephone Number : 207-799-0422
Fax Number : 207-799-5151
Provider Business Practice Location Address
First Line : 345 COTTAGE RD
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-3919
Country : US
Telephone Number : 207-799-0422
Fax Number : 207-799-5151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 07/08/2007

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