Healthcare Provider Details

I. General information

NPI: 1134874753
Provider Name (Legal Business Name): LISA BETH GRAFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 04/02/2023
Certification Date: 04/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 PEARL ST STE 3
STOUGHTON MA
02072-1617
US

IV. Provider business mailing address

249 DARRINGTON DR
RAYNHAM MA
02767-1551
US

V. Phone/Fax

Practice location:
  • Phone: 781-344-0057
  • Fax:
Mailing address:
  • Phone: 508-951-6035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2304375
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2304375
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: