Provider Demographics
NPI:1871731034
Name:ARCHER, GRACE A (MSW)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:A
Last Name:ARCHER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 EAST RIVER STREET
Mailing Address - Street 2:1411
Mailing Address - City:ORANGE
Mailing Address - State:MA
Mailing Address - Zip Code:01364-2105
Mailing Address - Country:US
Mailing Address - Phone:978-544-2448
Mailing Address - Fax:
Practice Address - Street 1:419 E RIVER ST
Practice Address - Street 2:1411
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-1847
Practice Address - Country:US
Practice Address - Phone:978-544-2448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2EFCEEACC8B7101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA451963800/451963801OtherBHL PROVIDER NUMBERS