Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 219591 | MA |
NPI | 1003200288 |
---|---|
Provider Name | Mrs. Michelle Lynne Gracey |
First Address | Newburyport, MA 01950-6215 |
Second Address | Newburyport, MA 01950-6215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2015 |
Last Update Date | 25/03/2015 |