Provider Demographics
NPI:1275684680
Name:GRAVEN MEAU, ANNEMIEKE (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:ANNEMIEKE
Middle Name:
Last Name:GRAVEN MEAU
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 LYMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5330
Mailing Address - Country:US
Mailing Address - Phone:802-363-7047
Mailing Address - Fax:
Practice Address - Street 1:59 LYMAN AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5330
Practice Address - Country:US
Practice Address - Phone:802-363-7047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011342Medicaid