Healthcare Provider Details

I. General information

NPI: 1720802986
Provider Name (Legal Business Name): GRAHAM BEHAVIOR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HIGHWAY 36
WEST LONG BRANCH NJ
07764-1463
US

IV. Provider business mailing address

60 HIGHWAY 36
WEST LONG BRANCH NJ
07764-1463
US

V. Phone/Fax

Practice location:
  • Phone: 848-888-3204
  • Fax:
Mailing address:
  • Phone: 848-888-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CARA MARIE GRAHAM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 848-888-3204