Provider Demographics
NPI:1942963749
Name:GRAHAM, JUDITH A (LMSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 STATE ROUTE 42
Mailing Address - Street 2:
Mailing Address - City:GRAHAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12740-7028
Mailing Address - Country:US
Mailing Address - Phone:845-332-9788
Mailing Address - Fax:
Practice Address - Street 1:7405 STATE ROUTE 42
Practice Address - Street 2:
Practice Address - City:GRAHAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12740-7028
Practice Address - Country:US
Practice Address - Phone:845-332-9788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1099501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical