Provider Demographics
NPI:1750611679
Name:GRAHAM, JENNIFER D (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:D
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15706 E WATERSIDE CIR
Mailing Address - Street 2:#206
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2279
Mailing Address - Country:US
Mailing Address - Phone:954-701-4033
Mailing Address - Fax:954-497-3622
Practice Address - Street 1:4200 NW 16TH ST
Practice Address - Street 2:#307
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-5899
Practice Address - Country:US
Practice Address - Phone:954-497-1420
Practice Address - Fax:954-497-3622
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist