Healthcare Provider Details

I. General information

NPI: 1083579429
Provider Name (Legal Business Name): ANDREA GRABER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 STATE ST
WASHINGTON IN
47501-8505
US

IV. Provider business mailing address

PO BOX 556
VINCENNES IN
47591-0556
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-1558
  • Fax: 812-254-8308
Mailing address:
  • Phone: 812-494-9501
  • Fax: 812-494-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33013195A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: