Provider Demographics
NPI:1245423391
Name:GRAIVER, DOUGLAS MITCHELL (LCSW, CCS)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:MITCHELL
Last Name:GRAIVER
Suffix:
Gender:M
Credentials:LCSW, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08559-2153
Mailing Address - Country:US
Mailing Address - Phone:609-397-5971
Mailing Address - Fax:
Practice Address - Street 1:56 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:NJ
Practice Address - Zip Code:08559-2153
Practice Address - Country:US
Practice Address - Phone:609-397-5971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC005959001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical