MEDICARE: REBECCA GRAHAM PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	009789	NY
2	103TC1900X	Counseling Psychologist	35785	CA

General Provider Information

NPI Number	:	1144902768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA GRAHAM PHD

Provider Business Mailing Address
First Line	:	2041 EAST ST STE 1241
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94520-2126
Country	:	US
Telephone Number	:	858-771-0556
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 EAST ST STE 1241
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94520-2126
Country	:	US
Telephone Number	:	858-771-0556
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	07/16/2025

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