Provider Demographics
NPI:1760653760
Name:STANLEY R GRAHAM PH D PC
Entity Type:Organization
Organization Name:STANLEY R GRAHAM PH D PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-989-2990
Mailing Address - Street 1:50 W 23RD ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5205
Mailing Address - Country:US
Mailing Address - Phone:212-995-8408
Mailing Address - Fax:212-792-6058
Practice Address - Street 1:50 W 23RD ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5205
Practice Address - Country:US
Practice Address - Phone:212-995-8408
Practice Address - Fax:212-792-6058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00390103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty