Healthcare Provider Details

I. General information

NPI: 1477474963
Provider Name (Legal Business Name): JONATHAN ALEXANDER GRAHAM MHC-LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 GIDNEY AVE STE 6
NEWBURGH NY
12550-2805
US

IV. Provider business mailing address

44 HUDSON VIEW DR APT C
BEACON NY
12508-1324
US

V. Phone/Fax

Practice location:
  • Phone: 845-569-2900
  • Fax:
Mailing address:
  • Phone: 805-245-6975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP144460
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: