Provider Demographics
NPI:1184719403
Name:GRAHAM, ROBERT JAMES (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1125
Mailing Address - Country:US
Mailing Address - Phone:716-882-1190
Mailing Address - Fax:716-882-1192
Practice Address - Street 1:36 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1125
Practice Address - Country:US
Practice Address - Phone:716-882-1190
Practice Address - Fax:716-882-1192
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0151592103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00027499101OtherUNIVERA HEALTH
NYRB0096Medicare ID - Type Unspecified