Provider Demographics
NPI:1033563523
Name:GRAHAM, ALYSSA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 SILAS DEANE HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2341
Mailing Address - Country:US
Mailing Address - Phone:860-222-2175
Mailing Address - Fax:
Practice Address - Street 1:2317 SILAS DEANE HWY STE 2
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2341
Practice Address - Country:US
Practice Address - Phone:860-222-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT101361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical