Provider Demographics
NPI:1861632507
Name:GRAHAM, MICHAEL SR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:GRAHAM
Suffix:SR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 HIGHLAND AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-4710
Mailing Address - Country:US
Mailing Address - Phone:203-757-0151
Mailing Address - Fax:203-757-0153
Practice Address - Street 1:796 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-4710
Practice Address - Country:US
Practice Address - Phone:203-757-0151
Practice Address - Fax:203-757-0153
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health