MEDICARE: MRS. SARAH GRAVES

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	SW10614	FL

General Provider Information

NPI Number	:	1235481367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH GRAVES

Provider Business Mailing Address
First Line	:	2116 PARK ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3812
Country	:	US
Telephone Number	:	904-251-8284
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 TRIESTE PL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-2325
Country	:	US
Telephone Number	:	904-304-0645
Fax Number	:

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

Provider Enumeration Date	:	10/13/2012
Last Update Date	:	10/13/2012

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