Provider Demographics
NPI:1134393515
Name:GRAHAM, JO ANN LANGE (MSW)
Entity type:Individual
Prefix:MRS
First Name:JO ANN
Middle Name:LANGE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 NORTH KILLIAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403
Mailing Address - Country:US
Mailing Address - Phone:561-635-4887
Mailing Address - Fax:561-688-8143
Practice Address - Street 1:1408 N KILLIAN DR STE 202
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-1961
Practice Address - Country:US
Practice Address - Phone:561-635-4887
Practice Address - Fax:561-688-8143
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW98081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical