MEDICARE: GARY GRAFF MA LADC

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	101Y00000X	Counselor	000385	VT
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	000385	VT
3	101YM0800X	Mental Health Counselor	000385	VT
4	101YP2500X	Professional Counselor	097.0072903	VT
5	101YA0400X	Addiction (Substance Use Disorder) Counselor	151.0127032	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902815608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY GRAFF MA LADC

Provider Business Mailing Address
First Line	:	390 RIVER STREET
Second Line	:	HCRS
City	:	SPRINGFIELD
State	:	VT
Zip	:	05156-2226
Country	:	US
Telephone Number	:	802-886-4500
Fax Number	:	802-886-4560

Provider Business Practice Location Address
First Line	:	51 FAIRVIEW STREET
Second Line	:	HCRS
City	:	BRATTLEBORO
State	:	VT
Zip	:	05301-6629
Country	:	US
Telephone Number	:	802-254-6028
Fax Number	:	802-442-7501

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	06/23/2021

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Directions to “ GARY GRAFF MA LADC” Practice Location

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