MEDICARE: MS. LISA E GRAUBART 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	052943-1	NY

General Provider Information

NPI Number	:	1366589145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA E GRAUBART LCSW

Provider Business Mailing Address
First Line	:	11751 220TH ST
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1608
Country	:	US
Telephone Number	:	917-470-7186
Fax Number	:	718-276-0395

Provider Business Practice Location Address
First Line	:	117-51 220TH. STREET
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1608
Country	:	US
Telephone Number	:	917-470-7186
Fax Number	:	718-276-0395

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	01/02/2022

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