Provider Demographics
NPI:1134587025
Name:GRAHAM-OWENS, RONI (MED)
Entity type:Individual
Prefix:
First Name:RONI
Middle Name:
Last Name:GRAHAM-OWENS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6833 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-2605
Mailing Address - Country:US
Mailing Address - Phone:215-668-8100
Mailing Address - Fax:
Practice Address - Street 1:6833 N 18TH ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19126-2605
Practice Address - Country:US
Practice Address - Phone:215-668-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002040103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst