Provider Demographics
NPI:1902617566
Name:ILORI, GRACE OPEYEMI
Entity type:Individual
Prefix:MISS
First Name:GRACE
Middle Name:OPEYEMI
Last Name:ILORI
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 1:9 BELLAIR ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-4064
Mailing Address - Country:US
Mailing Address - Phone:781-200-9369
Mailing Address - Fax:
Practice Address - Street 1:9 BELLAIR ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-4064
Practice Address - Country:US
Practice Address - Phone:781-200-9369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician