Provider Demographics
NPI:1548715204
Name:GRAZI, KIMBERLY Y (MSED)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:Y
Last Name:GRAZI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 AVENUE V
Mailing Address - Street 2:2ND FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4127
Mailing Address - Country:US
Mailing Address - Phone:646-441-8140
Mailing Address - Fax:
Practice Address - Street 1:1214 AVENUE V
Practice Address - Street 2:2ND FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4127
Practice Address - Country:US
Practice Address - Phone:646-441-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator