Provider Demographics
NPI:1265506554
Name:GRAYBEAL, CAROL A (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:GRAYBEAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FARLEY CIR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9252
Mailing Address - Country:US
Mailing Address - Phone:570-523-7509
Mailing Address - Fax:570-523-7599
Practice Address - Street 1:115 FARLEY CIR
Practice Address - Street 2:SUITE 202
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9252
Practice Address - Country:US
Practice Address - Phone:570-523-7509
Practice Address - Fax:570-523-7599
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACWO132391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGR752684Medicare ID - Type UnspecifiedMEDICARE GRP #