Provider Demographics
NPI:1902972920
Name:PESIKEY, GRACE A (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:A
Last Name:PESIKEY
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32140 OAK DR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-3663
Mailing Address - Country:US
Mailing Address - Phone:302-381-6648
Mailing Address - Fax:302-966-0006
Practice Address - Street 1:32140 OAK DR
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3663
Practice Address - Country:US
Practice Address - Phone:302-381-6648
Practice Address - Fax:302-966-0006
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ100001491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE270002OtherMEDICARE PTAN