Healthcare Provider Details

I. General information

NPI: 1154318905
Provider Name (Legal Business Name): CHRISTIANE MARGARETE GRAHAM LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13415 CONNECTICUT AVE SUITE 105
SILVER SPRING MD
20906-2910
US

IV. Provider business mailing address

4112 DECATUR AVE
KENSINGTON MD
20895-1507
US

V. Phone/Fax

Practice location:
  • Phone: 301-949-2624
  • Fax: 301-946-0340
Mailing address:
  • Phone: 301-949-2624
  • Fax: 301-946-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10877
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierF557-0001
Identifier TypeOTHER
Identifier StateDC
Identifier IssuerFED BC/BS
# 2
IdentifierQG14CM
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerCARE FIRST

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: