Provider Demographics
NPI:1326635665
Name:GRAHAM, CARLEEN A
Entity type:Individual
Prefix:
First Name:CARLEEN
Middle Name:A
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 MAIN ST STE 700
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2112
Mailing Address - Country:US
Mailing Address - Phone:862-200-7218
Mailing Address - Fax:888-384-2561
Practice Address - Street 1:368 MAIN ST STE 700
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2112
Practice Address - Country:US
Practice Address - Phone:862-200-7218
Practice Address - Fax:888-384-2561
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00645000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional