Provider Demographics
NPI:1285074989
Name:GRAHAM-FOURNILLIER, BEVERLY DIANNE (MSW)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:DIANNE
Last Name:GRAHAM-FOURNILLIER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900B RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5302
Mailing Address - Country:US
Mailing Address - Phone:718-253-1366
Mailing Address - Fax:718-253-5890
Practice Address - Street 1:1900B RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5302
Practice Address - Country:US
Practice Address - Phone:718-253-1366
Practice Address - Fax:718-253-5890
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker