Provider Demographics
NPI:1538866710
Name:GRACIANO, MERCEDELLI
Entity type:Individual
Prefix:
First Name:MERCEDELLI
Middle Name:
Last Name:GRACIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 KINGS WAY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-1520
Mailing Address - Country:US
Mailing Address - Phone:914-733-8654
Mailing Address - Fax:
Practice Address - Street 1:2602 KINGS WAY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-1520
Practice Address - Country:US
Practice Address - Phone:914-733-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013172101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor