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General NPI Number Information
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NPI Number | 1053512137
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Entity Type | Individual
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Provider Name | MICHAEL ANTHONY GRAZIANO M.ED. L.M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2000 OLD WEST CHESTER PIKE
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City | HAVERTOWN
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State | PA
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Zip | 19083-2712
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Country | US
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Telephone | 484-454-8780
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Fax | 484-454-8810
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Provider Business Mailing Address
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Address Line | 17 N MORGAN AVE
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City | HAVERTOWN
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State | PA
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Zip | 19083-5007
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Country | US
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Telephone | 610-449-0428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MF000316
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License Number State | PA
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