Provider Demographics
NPI:1750795837
Name:MCGRAW, STEPHANIE (PSYD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 FOUNDATION WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9000
Mailing Address - Country:US
Mailing Address - Phone:304-264-9002
Mailing Address - Fax:304-264-9042
Practice Address - Street 1:2004 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8808
Practice Address - Country:US
Practice Address - Phone:304-596-5780
Practice Address - Fax:304-596-5781
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1117103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical