MEDICARE: LISA GRAFF-MARSH, 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	1041C0700X	Clinical Social Worker	LCSW16077	CA

General Provider Information

NPI Number	:	1316482995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA GRAFF-MARSH, INC.

Provider Business Mailing Address
First Line	:	4985 PARK RIM DR.
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117
Country	:	US
Telephone Number	:	858-272-9812
Fax Number	:	858-272-9812

Provider Business Practice Location Address
First Line	:	4985 PARK RIM DR.
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117
Country	:	US
Telephone Number	:	858-272-9812
Fax Number	:	858-272-9812

Authorized Official
Title or Position	:	CEO
Name	:	MRS. LISA GRAFF-MARSH
Credential	:
Telephone Number	:	858-272-9812

Provider Enumeration Date	:	01/05/2017
Last Update Date	:	01/05/2017

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