Basic Information
| Provider Information | |||||||||
| NPI: | 1760578157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAFF | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, GACS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 326 | ||||||||
| Address2: | |||||||||
| City: | BASS HARBOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046530326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072445157 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 322 MAIN ST | ||||||||
| Address2: | MDI BEHAVIORAL HEALTH CENTER | ||||||||
| City: | BAR HARBOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046091637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072888604 | ||||||||
| FaxNumber: | 2072888602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 03/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | CC1000 | ME | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | CC1000 | 01 | ME | LICENSE | OTHER |