Jacqueline S. Graybeal, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34001775A Issued in IN

Practice address

1807 Smith St
Logansport, IN 46947-1576

Phone

(574) 732-1414

Fax

(574) 732-0504

NPI assigned

Jul 5, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Four County Comprehensive Mental Health Center, Inc

  • Psychiatric Hospital
  • Peru, IN
  • NPI 1457539751
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487685756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 MICHIGAN AVE",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471526",
            "telephone_number": "574-722-5151",
            "fax_number": "574-739-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 SMITH ST",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471576",
            "telephone_number": "574-732-1414",
            "fax_number": "574-732-0504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAYBEAL",
        "first_name": "JACQUELINE",
        "middle_name": "S.",
        "name_prefix": "Mrs.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34001775A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "549330",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Graham Enterprises LLC
• Tyler Maitland Graham, DC
• Joni Grandstaff, LPN
• Grandview Care Inc
• Adrienne Grant, MA
• Tiffany Nicole Grenier, BS
• Deborah L. Grimes, RN
• Isabella Darlene Gunther
• Samuel Arthur Gunther
• Charles R Guthrie, BA

• Clinical Social Worker in Logansport, IN
• Providers in Logansport, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.