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General NPI Number Information
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NPI Number | 1740915677
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Entity Type | Individual
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Provider Name | LAVETTE GOODMAN GRAHAM PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/24/2022
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Last Update Date | 11/29/2025
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Provider Practice Location Address
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Address Line | 1133 SOUTH BLVD APT 901
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City | OAK PARK
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State | IL
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Zip | 60302-4279
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Country | US
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Telephone | 201-616-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 1133 SOUTH BLVD APT 901
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City | OAK PARK
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State | IL
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Zip | 60302-4279
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Country | US
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Telephone | 201-616-8181
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209.032017
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 041.472420
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 309.023545
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License Number State | IL
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