Provider Demographics
NPI:1710266036
Name:GRAHAM, WARREN K (LCSW, LMSW, CASAC)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:K
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:LCSW, LMSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MERRICK AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3433
Mailing Address - Country:US
Mailing Address - Phone:516-984-7986
Mailing Address - Fax:516-442-2347
Practice Address - Street 1:28 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3433
Practice Address - Country:US
Practice Address - Phone:516-984-7986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19876101YA0400X
NY076411104100000X
NY0898231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker