MEDICARE: MS. CHRISTIANE MARGARETE GRAHAM LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	10877	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F557-0001	OTHER	DC	FED BC/BS
2	QG14CM	OTHER	MD	CARE FIRST

General Provider Information

NPI Number	:	1154318905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTIANE MARGARETE GRAHAM LCSW-C

Provider Business Mailing Address
First Line	:	4112 DECATUR AVE
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-1507
Country	:	US
Telephone Number	:	301-949-2624
Fax Number	:	301-946-0340

Provider Business Practice Location Address
First Line	:	13415 CONNECTICUT AVE
Second Line	:	SUITE 105
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-2910
Country	:	US
Telephone Number	:	301-949-2624
Fax Number	:	301-946-0340

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	10/04/2007

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