Provider Demographics
NPI:1649023441
Name:GRABER, JENNIFER S (EDD, PMHCNS-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:GRABER
Suffix:
Gender:F
Credentials:EDD, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 SALEM CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2942
Mailing Address - Country:US
Mailing Address - Phone:302-635-0652
Mailing Address - Fax:
Practice Address - Street 1:100 ROCKLAND RD W
Practice Address - Street 2:STE K1
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807
Practice Address - Country:US
Practice Address - Phone:302-365-0325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELE-0000155364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health