Provider Demographics
NPI:1902815608
Name:GRAFF, GARY (MA LADC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:GRAFF
Suffix:
Gender:M
Credentials:MA LADC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:390 RIVER STREET
Mailing Address - Street 2:HCRS
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2226
Mailing Address - Country:US
Mailing Address - Phone:802-886-4500
Mailing Address - Fax:802-886-4560
Practice Address - Street 1:51 FAIRVIEW STREET
Practice Address - Street 2:HCRS
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6629
Practice Address - Country:US
Practice Address - Phone:802-254-6028
Practice Address - Fax:802-442-7501
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT000385101Y00000X, 101YA0400X, 101YM0800X
VT097.0072903101YP2500X
VT151.0127032101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1026203Medicaid