Provider Demographics
NPI:1578990958
Name:GRAVES, SHANI (LMHC)
Entity Type:Individual
Prefix:
First Name:SHANI
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MACDONOUGH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2303
Mailing Address - Country:US
Mailing Address - Phone:347-409-0787
Mailing Address - Fax:
Practice Address - Street 1:260 BROADWAY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8433
Practice Address - Country:US
Practice Address - Phone:347-505-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP90401101YM0800X
NY006671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health