Provider Demographics
NPI:1356434583
Name:GRAFF, ELLEN SMITH (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:SMITH
Last Name:GRAFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 NORTH BEDFORD DR
Mailing Address - Street 2:# 216
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-205-0631
Mailing Address - Fax:310-394-6074
Practice Address - Street 1:360 NORTH BEDFORD DR
Practice Address - Street 2:# 216
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-205-0631
Practice Address - Fax:310-394-6074
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10327103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL103270OtherBLUE SHIELD OF CALIF
CP10327Medicare ID - Type Unspecified