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General NPI Number Information
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NPI Number | 1760873418
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Entity Type | Organization
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Legal Business Name | STEVEN W. GRAHAM, LCSW
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Dates
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Enumeration Date | 02/16/2015
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 1075 TOLLAND TPKE
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City | MANCHESTER
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State | CT
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Zip | 06042-1609
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Country | US
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Telephone | 860-432-9229
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Fax |
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Provider Business Mailing Address
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Address Line | 63 SUMMIT ST APT. 14
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City | MANCHESTER
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State | CT
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Zip | 06040-4254
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Country | US
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Telephone | 860-432-9229
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Fax | 860-432-8333
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MR. STEVEN W GRAHAM
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Credential | LCSW
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Telephone | 860-432-9229
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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 | 008870
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License Number State | CT
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