Provider Demographics
NPI:1073378527
Name:GRAFF, LISA M (LSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:GRAFF
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TRADE CENTRE DR STE 302
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7233
Mailing Address - Country:US
Mailing Address - Phone:217-731-4638
Mailing Address - Fax:
Practice Address - Street 1:100 TRADE CENTRE DR STE 302
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7233
Practice Address - Country:US
Practice Address - Phone:217-731-4638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.113228104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker