Provider Demographics
NPI:1003121195
Name:GRAHAM, ALISTAIR (LCSW)
Entity Type:Individual
Prefix:
First Name:ALISTAIR
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 EAST 11TH STREET, SUITE 622
Mailing Address - Street 2:DBA ALISTAIR GRAHAM PSYCHOTHERAPY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:917-267-0696
Mailing Address - Fax:212-210-6897
Practice Address - Street 1:80 EAST 11TH STREET, SUITE 622
Practice Address - Street 2:DBA ALISTAIR GRAHAM PSYCHOTHERAPY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:917-267-0696
Practice Address - Fax:212-210-6897
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical