Provider Demographics
NPI:1508550963
Name:GRACE, LINDSY SUSANA BLANCO
Entity type:Individual
Prefix:
First Name:LINDSY
Middle Name:SUSANA BLANCO
Last Name:GRACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDSY
Other - Middle Name:
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:200 7TH AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4669
Mailing Address - Country:US
Mailing Address - Phone:831-278-7915
Mailing Address - Fax:
Practice Address - Street 1:200 7TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-4669
Practice Address - Country:US
Practice Address - Phone:831-278-7915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22727101YA0400X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician