Provider Demographics
NPI:1821680224
Name:GRAHAM, CARLENE (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:
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 1:755 E COOPER FERRY CT
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-3108
Mailing Address - Country:US
Mailing Address - Phone:609-377-0063
Mailing Address - Fax:
Practice Address - Street 1:755 E COOPER FERRY CT
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-3108
Practice Address - Country:US
Practice Address - Phone:609-377-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059187001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical