Provider Demographics
NPI:1376816959
Name:GRAHAM, NANCY B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:B
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 1:214 ENGLE ST
Mailing Address - Street 2:SUITE 23
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2443
Mailing Address - Country:US
Mailing Address - Phone:201-615-1475
Mailing Address - Fax:
Practice Address - Street 1:326 ORANGEBURGH RD
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-7449
Practice Address - Country:US
Practice Address - Phone:201-615-1475
Practice Address - Fax:201-784-2621
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC013926001041C0700X
NY020742-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical