Healthcare Provider Details

I. General information

NPI: 1962165449
Provider Name (Legal Business Name): HOLLY REBEKAH GRAFF LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 LINCOLN ST
MONTCLAIR NJ
07042-4430
US

IV. Provider business mailing address

159 LINCOLN ST
MONTCLAIR NJ
07042-4430
US

V. Phone/Fax

Practice location:
  • Phone: 917-992-4623
  • Fax:
Mailing address:
  • Phone: 917-992-4623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-316788
License Number State
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number25MW00003700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: