Provider Demographics
NPI:1134717242
Name:GRAZIANO, MICHELE GRAZIANO F (CASAC)
Entity type:Individual
Prefix:MRS
First Name:MICHELE GRAZIANO
Middle Name:F
Last Name:GRAZIANO
Suffix:
Gender:F
Credentials:CASAC
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Mailing Address - Street 1:1 FARMINGDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-1522
Mailing Address - Country:US
Mailing Address - Phone:631-447-6460
Mailing Address - Fax:631-289-7098
Practice Address - Street 1:456 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1586
Practice Address - Country:US
Practice Address - Phone:631-477-6460
Practice Address - Fax:631-289-7098
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)