Provider Demographics
NPI:1063634251
Name:GRAHAM, DONALD E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:E
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 1:303 E. TIOGA ST.
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-8210
Mailing Address - Country:US
Mailing Address - Phone:610-965-9021
Mailing Address - Fax:610-965-6227
Practice Address - Street 1:303 E TIOGA ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-8210
Practice Address - Country:US
Practice Address - Phone:610-965-9021
Practice Address - Fax:610-965-6227
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW01285821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA542428Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER