MEDICARE: MS. MARY CATHERINE GRAHAM

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	101YP2500X	Professional Counselor	PA016164	PA

General Provider Information

NPI Number	:	1720259138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY CATHERINE GRAHAM

Provider Business Mailing Address
First Line	:	142 GRASMERE ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15205-4219
Country	:	US
Telephone Number	:	724-614-0021
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 WABASH ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15220-5435
Country	:	US
Telephone Number	:	412-455-6890
Fax Number	:

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

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	11/20/2023

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