MEDICARE: MS. ELIZABETH GRAHAM LCSW

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	1041C0700X	Clinical Social Worker	0904007295	VA

General Provider Information

NPI Number	:	1104148592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH GRAHAM LCSW

Provider Business Mailing Address
First Line	:	975 WAKEFIELD FARM
Second Line	:
City	:	EARLYSVILLE
State	:	VA
Zip	:	22936-9522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4830 W HUNDRED RD
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-1775
Country	:	US
Telephone Number	:	804-606-0272
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	12/19/2025

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