Provider Demographics
NPI:1104689397
Name:SWABY GRIER, ALECIA ANTOINETTE
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:ANTOINETTE
Last Name:SWABY GRIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 HAWKINS ST
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1517
Mailing Address - Country:US
Mailing Address - Phone:203-522-8931
Mailing Address - Fax:
Practice Address - Street 1:231 HAWKINS ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1517
Practice Address - Country:US
Practice Address - Phone:203-522-8931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT135791163W00000X
CT12910363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse