Provider Demographics
NPI:1134510274
Name:GRAHAM, YVETTE
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YVETTE
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:590 LOWER LANDING RD
Mailing Address - Street 2:UNIT 213
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-4325
Mailing Address - Country:US
Mailing Address - Phone:609-792-4915
Mailing Address - Fax:
Practice Address - Street 1:590 LOWER LANDING RD
Practice Address - Street 2:UNIT 213
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-4325
Practice Address - Country:US
Practice Address - Phone:609-792-4915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health