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General NPI Number Information
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NPI Number | 1174518831
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Entity Type | Individual
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Provider Name | SALLY GRAHAM PHD
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Gender | Female
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 24 E 12TH ST 601A
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City | NEW YORK
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State | NY
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Zip | 10003-4403
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Country | US
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Telephone | 212-807-0543
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Fax |
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Provider Business Mailing Address
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Address Line | 7 E 14TH ST 1410
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City | NEW YORK
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State | NY
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Zip | 10003-3122
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Country | US
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Telephone | 212-803-5412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | NY005618
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License Number State | NY
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