=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316482995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LISA GRAFF-MARSH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2017
-----------------------------------------------------
Last Update Date | 01/05/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4985 PARK RIM DR.
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-272-9812
-----------------------------------------------------
Fax | 858-272-9812
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4985 PARK RIM DR.
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-272-9812
-----------------------------------------------------
Fax | 858-272-9812
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. LISA GRAFF-MARSH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 858-272-9812
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW16077
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------