Provider Demographics
NPI:1336937796
Name:GRAVES, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:GRAVES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 TERRAPIN CIR
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-3043
Mailing Address - Country:US
Mailing Address - Phone:609-225-0227
Mailing Address - Fax:
Practice Address - Street 1:1655 TERRAPIN CIR
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-3043
Practice Address - Country:US
Practice Address - Phone:609-225-0227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD37628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health