Healthcare Provider Details

I. General information

NPI: 1033527312
Provider Name (Legal Business Name): LOUIS GRAFF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 S MAIN ST SUITE 201
WEST HARTFORD CT
06107-2445
US

IV. Provider business mailing address

68 S MAIN ST SUITE 201
WEST HARTFORD CT
06107-2445
US

V. Phone/Fax

Practice location:
  • Phone: 860-748-7773
  • Fax: 860-561-6184
Mailing address:
  • Phone: 860-748-7773
  • Fax: 860-561-6184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number051198
License Number StateCT

VIII. Authorized Official

Name: DR. LOUIS G FOROUHAR-GRAFF
Title or Position: DIRECTOR
Credential: M.D.
Phone: 860-748-7773