Provider Demographics
NPI:1275731911
Name:GRAHAM, STEVEN RIESTER (ASW)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RIESTER
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 54TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-3131
Mailing Address - Country:US
Mailing Address - Phone:510-914-6881
Mailing Address - Fax:
Practice Address - Street 1:2850 WEST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-4536
Practice Address - Country:US
Practice Address - Phone:510-879-8481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 176801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical