Provider Demographics
NPI:1902991516
Name:GRAVES, JAMES ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:GRAVES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6 LYBERTY WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3616
Mailing Address - Country:US
Mailing Address - Phone:978-496-2050
Mailing Address - Fax:978-496-2051
Practice Address - Street 1:6 LYBERTY WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3616
Practice Address - Country:US
Practice Address - Phone:978-496-2050
Practice Address - Fax:978-496-2051
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2413103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist