MEDICARE: MRS. GRACE BONNEY KANEKO

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	101YP2500X	Professional Counselor	15999	CA

General Provider Information

NPI Number	:	1720702954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRACE BONNEY KANEKO

Provider Business Mailing Address
First Line	:	332 KEAP ST APT 4K
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-6437
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	332 KEAP ST APT 4K
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-6437
Country	:	US
Telephone Number	:	779-423-7635
Fax Number	:

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

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	12/09/2025

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