Provider Demographics
NPI:1114084571
Name:GRABER, EVAN PAUL (PHD)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:PAUL
Last Name:GRABER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WILLOW BROOK RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2719
Mailing Address - Country:US
Mailing Address - Phone:508-829-2275
Mailing Address - Fax:
Practice Address - Street 1:57 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2183
Practice Address - Country:US
Practice Address - Phone:508-829-2275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4583103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04423OtherBCBSMA
MA004870OtherHPHC
MA5631229OtherAETNA