Provider Demographics
NPI:1215029665
Name:GRAHAM, JOAN MASON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:MASON
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 1:34 MARYS LN
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1118
Mailing Address - Country:US
Mailing Address - Phone:631-757-4670
Mailing Address - Fax:
Practice Address - Street 1:34 MARYS LN
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1118
Practice Address - Country:US
Practice Address - Phone:631-757-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO11593-1101YM0800X
NYPRJO11593-1101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional