Provider Demographics
NPI:1770665242
Name:GRAHAM, CHARLES (MSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-3302
Mailing Address - Country:US
Mailing Address - Phone:856-857-1656
Mailing Address - Fax:
Practice Address - Street 1:12000 LINCOLN DR W
Practice Address - Street 2:SUITE 407 PAVILIONS AT GREENTREE
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3402
Practice Address - Country:US
Practice Address - Phone:856-985-3404
Practice Address - Fax:856-985-7847
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC013380001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical