MEDICARE: MS. SADE K GRAVES 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	CW023224	PA

General Provider Information

NPI Number	:	1285334177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SADE K GRAVES LCSW

Provider Business Mailing Address
First Line	:	8302 OLD YORK RD STE B1
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8302 OLD YORK RD STE B1
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1529
Country	:	US
Telephone Number	:	215-645-2343
Fax Number	:

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

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	02/28/2024

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