Provider Demographics
NPI:1194565531
Name:MARGIOTTA, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MARGIOTTA
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 1:39 BARTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2939
Mailing Address - Country:US
Mailing Address - Phone:321-544-9741
Mailing Address - Fax:
Practice Address - Street 1:5115 ANZIO ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8407
Practice Address - Country:US
Practice Address - Phone:407-226-1714
Practice Address - Fax:407-226-2922
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical