Provider Demographics
NPI:1346953288
Name:GRAVES, MOLLY (LMSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BEARTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PORT CRANE
Mailing Address - State:NY
Mailing Address - Zip Code:13833-1104
Mailing Address - Country:US
Mailing Address - Phone:570-295-8498
Mailing Address - Fax:
Practice Address - Street 1:783 CHENANGO ST STE D
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-1870
Practice Address - Country:US
Practice Address - Phone:570-295-8498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097432104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker