Provider Demographics
NPI:1255572392
Name:GRAF, BENJAMIN MICAH (LCSW)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MICAH
Last Name:GRAF
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21700 REDWOOD RD
Mailing Address - Street 2:STE. B
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-6434
Mailing Address - Country:US
Mailing Address - Phone:510-394-2150
Mailing Address - Fax:
Practice Address - Street 1:21700 REDWOOD RD
Practice Address - Street 2:STE. B
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-6434
Practice Address - Country:US
Practice Address - Phone:510-394-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25770101YM0800X
CA640021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health