Individual
MR. BRIAN JOHN GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC, MBA, RN
Contact information
Practice address
10 CABOT RD STE 201, MEDFORD, MA 02155-5173
(800) 915-3211
Mailing address
10 CABOT RD STE 201, MEDFORD, MA 02155-5173
(800) 915-3211
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2022010797
MA
Other
Enumeration date
06/29/2022
Last updated
06/29/2022
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