| NPI | 1174800791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHAN A GRAHAM Psychologist 718-702-2437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 018415) |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2011-11-10 |