Provider Demographics
NPI:1508914755
Name:GRAVES, PATRICIA F (LICSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:F
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 1:280 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3537
Mailing Address - Country:US
Mailing Address - Phone:401-782-6149
Mailing Address - Fax:401-782-6149
Practice Address - Street 1:23 NORTH RD
Practice Address - Street 2:LILY PADS PROFESSIONAL CENTER
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-2176
Practice Address - Country:US
Practice Address - Phone:401-782-6149
Practice Address - Fax:401-782-6149
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW00739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health