Provider Demographics
NPI:1043329865
Name:GRAYBILL, DENNIS (LIC PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:GRAYBILL
Suffix:
Gender:M
Credentials:LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 ERFORD RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1117
Mailing Address - Country:US
Mailing Address - Phone:717-732-2917
Mailing Address - Fax:717-732-5375
Practice Address - Street 1:412 ERFORD RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1117
Practice Address - Country:US
Practice Address - Phone:717-732-2917
Practice Address - Fax:717-732-5375
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002712L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist