Provider Demographics
NPI:1871301465
Name:OLIVEIRA, GRACIE (LSW)
Entity type:Individual
Prefix:
First Name:GRACIE
Middle Name:
Last Name:OLIVEIRA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W CAINES DR
Mailing Address - Street 2:
Mailing Address - City:CREAM RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08514-2323
Mailing Address - Country:US
Mailing Address - Phone:201-874-3029
Mailing Address - Fax:
Practice Address - Street 1:949 LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1057
Practice Address - Country:US
Practice Address - Phone:848-373-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07228900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker