MEDICARE: MS. HARRIET GRAZMAN 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	0149787S	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6007763	OTHER	IL	BCBS IL
2	170343	OTHER	MO	BCBS MO
3	179644	OTHER	IL	VALUE OPTIONS
4	5428303	OTHER	IL	AETNA
5	6212004	OTHER	IL	UNITED HEALTHCARE-UBH

General Provider Information

NPI Number	:	1508897257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HARRIET GRAZMAN LCSW

Provider Business Mailing Address
First Line	:	6-B GLEN-ED PROFESSIONAL PARK
Second Line	:
City	:	GLEN CARBON
State	:	IL
Zip	:	62034-3333
Country	:	US
Telephone Number	:	618-692-9600
Fax Number	:	618-692-9607

Provider Business Practice Location Address
First Line	:	6-B GLEN-ED PROFESSIONAL PARK
Second Line	:
City	:	GLEN CARBON
State	:	IL
Zip	:	62034-3333
Country	:	US
Telephone Number	:	618-692-9600
Fax Number	:	618-692-9607

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/08/2007

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