MEDICARE: STACEY ALLENE GRAZIANO SCHOOL PSYCHOLOGIST

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
1	103TS0200X	School Psychologist	319903	NM
2	103TC0700X	Clinical Psychologist	9444446-2501	UT
3	103T00000X	Psychologist	1444	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245309087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY ALLENE GRAZIANO SCHOOL PSYCHOLOGIST

Provider Business Mailing Address
First Line	:	PO BOX 14003
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88013-4003
Country	:	US
Telephone Number	:	801-609-8037
Fax Number	:

Provider Business Practice Location Address
First Line	:	1990 E LOHMAN AVE STE 213
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3172
Country	:	US
Telephone Number	:	801-609-8037
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	11/24/2025

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