Active NPI
Diane J Gracewski, LICSW
- Clinical Social Worker
- Old Saybrook, CT
National Provider Identifier
1104066042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 002292
- Practice address
- 20 Research Pkwy
C
Old Saybrook, CT 06475-4214 - Phone
- (800) 370-3651
- Fax
- (860) 510-0020
- NPI assigned
- Mar 5, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 002292 | CT | Primary |
Addresses
Primary practice location
20 Research Pkwy
C
Old Saybrook, CT 06475-4214
Mailing address
20 Research Pkwy
C
Old Saybrook, CT 06475-4214
Phone (800) 370-3651
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002292 | CT | MD | Psychologist |
| 2292 | CT | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236211200000",
"number": "1104066042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 RESEARCH PKWY",
"address_2": "C",
"city": "OLD SAYBROOK",
"state": "CT",
"postal_code": "064754214",
"telephone_number": "800-370-3651",
"fax_number": "860-510-0020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 RESEARCH PKWY",
"address_2": "C",
"city": "OLD SAYBROOK",
"state": "CT",
"postal_code": "064754214",
"telephone_number": "800-370-3651",
"fax_number": "860-510-0020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRACEWSKI",
"first_name": "DIANE",
"middle_name": "J",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-05",
"last_updated": "2009-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "002292",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Old Saybrook, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.