Provider Demographics
NPI:1164965208
Name:GRAVES, JONAH
Entity Type:Individual
Prefix:
First Name:JONAH
Middle Name:
Last Name:GRAVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 CARPENTER AVE
Mailing Address - Street 2:3A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1338
Mailing Address - Country:US
Mailing Address - Phone:718-994-4941
Mailing Address - Fax:
Practice Address - Street 1:4305 CARPENTER AVE
Practice Address - Street 2:3A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1338
Practice Address - Country:US
Practice Address - Phone:718-994-4941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst