Provider Demographics
NPI:1619576949
Name:GRAF, ILEANA (LMFT)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:GRAF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N MAIN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4993
Mailing Address - Country:US
Mailing Address - Phone:860-506-7991
Mailing Address - Fax:
Practice Address - Street 1:225 N MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4993
Practice Address - Country:US
Practice Address - Phone:860-506-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001165106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist