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General NPI Number Information
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NPI Number | 1235630880
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Entity Type | Individual
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Provider Name | CAROLINE GRAHAM MSW, LCSW, LPHA
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Gender | Female
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 1205 MACKAY PL
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City | SAINT LOUIS
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State | MO
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Zip | 63104-2407
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Country | US
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Telephone | 573-353-6291
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 430001
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City | SAINT LOUIS
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State | MO
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Zip | 63143-0101
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Country | US
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Telephone | 573-353-6291
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149021922
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2020012397
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License Number State | MO
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