Provider Demographics
NPI:1649302407
Name:MCGRAW, RICHARD C (LCSW)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:MCGRAW
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 1:2722 JACQUES DR
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-4379
Mailing Address - Country:US
Mailing Address - Phone:573-358-8984
Mailing Address - Fax:573-358-8984
Practice Address - Street 1:2722 JACQUES DR
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-4379
Practice Address - Country:US
Practice Address - Phone:573-358-8984
Practice Address - Fax:573-358-8984
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0008761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical