MEDICARE: EVA MARIE THIBAUDEAU GRACZYK LCSW-S

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	1041C0700X	Clinical Social Worker	360538	TX

General Provider Information

NPI Number	:	1376439125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA MARIE THIBAUDEAU GRACZYK LCSW-S

Provider Business Mailing Address
First Line	:	5726 CARTAGENA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-2510
Country	:	US
Telephone Number	:	713-882-8274
Fax Number	:

Provider Business Practice Location Address
First Line	:	5726 CARTAGENA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-2510
Country	:	US
Telephone Number	:	713-882-8274
Fax Number	:

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

Provider Enumeration Date	:	06/17/2025
Last Update Date	:	06/17/2025

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