Provider Demographics
NPI:1114269172
Name:GRAVES, MANDY (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4049
Mailing Address - Country:US
Mailing Address - Phone:603-226-1999
Mailing Address - Fax:603-224-1675
Practice Address - Street 1:33 WARREN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4049
Practice Address - Country:US
Practice Address - Phone:603-226-1999
Practice Address - Fax:603-224-1675
Is Sole Proprietor?:No
Enumeration Date:2013-03-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical