Provider Demographics
NPI:1063963452
Name:GRAHAM, WHITNEY (MA, BCBA)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11271 SW 45TH MNR
Mailing Address - Street 2:UNIT 302
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7904
Mailing Address - Country:US
Mailing Address - Phone:305-803-7941
Mailing Address - Fax:
Practice Address - Street 1:11271 SW 45TH MNR
Practice Address - Street 2:UNIT 302
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7904
Practice Address - Country:US
Practice Address - Phone:305-803-7941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-16-23407103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst