MEDICARE: GRAFTON, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	SEVERAL	VA
2	101Y00000X	Counselor	SEVERAL	VA
3	103G00000X	Clinical Neuropsychologist	SEVERAL	VA
4	103T00000X	Psychologist	SEVERAL	VA
5	103TC0700X	Clinical Psychologist	SEVERAL	VA
6	104100000X	Social Worker	SEVERAL	VA
7	1041C0700X	Clinical Social Worker	SEVERAL	VA
8	2084P0804X	Child & Adolescent Psychiatry Physician	SEVERAL	VA
9	2084P0800X	Psychiatry Physician	SEVERAL	VA

General Provider Information

NPI Number	:	1083791511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAFTON, INC

Provider Business Mailing Address
First Line	:	PO BOX 2500
Second Line	:	FINANCE
City	:	WINCHESTER
State	:	VA
Zip	:	22604-1700
Country	:	US
Telephone Number	:	540-542-0200
Fax Number	:	540-542-0218

Provider Business Practice Location Address
First Line	:	801 CHILDRENS CENTER RD SW
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-2545
Country	:	US
Telephone Number	:	703-777-3485
Fax Number	:	703-777-4887

Authorized Official
Title or Position	:	DIRECTOR, ACCOUNTS RECEIVABLE
Name	:	MRS. VANESSA LANE JR.
Credential	:
Telephone Number	:	540-542-0200

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	10/19/2011

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