Individual
GRACE SA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
103 E.125TH ST, NEW YORK, NY 10035-1641
(212) 774-3271
Mailing address
103 E.125TH ST, NEW YORK, NY 10035-1641
(212) 774-3271
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
470129
NY
Other
Enumeration date
11/07/2023
Last updated
11/07/2023
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