Ethan a Graham PHD Psychologist PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

018415 Issued in NY

Legal business name

ETHAN A GRAHAM PHD PSYCHOLOGIST PLLC

Practice address

330 West 58TH Street
Suite 405
New York, NY 10019-1820

Phone

(718) 702-2437

NPI assigned

Nov 10, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ethan A Graham, PH.D.

Title

Psychologist

Phone

(718) 702-2437

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320883200000",
    "number": "1174800791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 WEST 58TH STREET",
            "address_2": "SUITE 405",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191820",
            "telephone_number": "718-702-2437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 WEST 58TH STREET",
            "address_2": "SUITE 405",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191820",
            "telephone_number": "718-702-2437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHAN A GRAHAM PHD PSYCHOLOGIST PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-10",
        "last_updated": "2011-11-10",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "718-702-2437",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "018415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.