Individual provider Active NPI

Cindy M Gracey, LICSW

  • Clinical Social Worker
  • Kent, WA
National Provider Identifier
1497219844
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LW61531476 Issued in WA
Practice address
11232 SE 267TH PL
Kent, WA 98030-7179
Phone
(206) 931-4945
NPI assigned
Jan 29, 2019
Reactivated
Jun 26, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SC61078861 WA
Behavior Technician 106S00000X
Clinical Social Worker 1041C0700X LW61531476 WA Primary

Addresses

Primary practice location

11232 SE 267TH PL
Kent, WA 98030-7179

Mailing address

11232 SE 267TH PL
Kent, WA 98030-7179
Phone (206) 931-4945

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240528001528 WA Practitioner - Clinical Social Worker 0446692073 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians

Practice addresses (Care Compare)

101 Elliott Ave W
Suite 500
Seattle, WA 98119-4292
Phone (425) 640-7009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LW61531476WAMDClinical Social Worker
SC61078861WAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mindful Therapy Group PC Clinical CurrentSince May 23, 2024 Accepting new patients

Locations

21907 64th Ave W
Ste 200
Mountlake Terrace, WA 98043
Phone (410) 258-3698

6505 216th St SW
Ste 100
Mountlake Terrace, WA 98043
Phone (425) 678-6463

320 NE 97th St
Ste A
Seattle, WA 98115
Phone (206) 323-8113

101 Elliott Ave W
Ste 500
Seattle, WA 98119
Phone (206) 708-6432

201 W North River Dr
Ste 301
Spokane, WA 99201
Phone (509) 496-0724

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1497219844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11232 SE 267TH PL",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980307179",
            "telephone_number": "206-931-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11232 SE 267TH PL",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980307179",
            "telephone_number": "206-931-4945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRACEY",
        "first_name": "CINDY",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-29",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "deactivation_date": "2023-06-07",
        "reactivation_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SC61078861",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61531476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kent, WA

Sources for this page

Verify at the official NPI Registry.