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General NPI Number Information
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NPI Number | 1710266036
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Entity Type | Individual
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Provider Name | WARREN K GRAHAM LCSW, LMSW, CASAC
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Gender | Male
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 28 MERRICK AVE
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City | MERRICK
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State | NY
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Zip | 11566-3433
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Country | US
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Telephone | 516-984-7986
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Fax |
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Provider Business Mailing Address
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Address Line | 28 MERRICK AVE STE 9
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City | MERRICK
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State | NY
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Zip | 11566-3433
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Country | US
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Telephone | 516-984-7986
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Fax | 516-442-2347
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 19876
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 076411
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 089823
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License Number State | NY
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