Jenna Michelle Graham, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW22054 Issued in FL

Practice address

4500 W Midway Rd
Fort Pierce, FL 34981-4823

Phone

(772) 204-4142

NPI assigned

Oct 10, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1696896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1265213870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1634 SW JANETTE AVE",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349531189",
            "telephone_number": "772-307-0460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 W MIDWAY RD",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349814823",
            "telephone_number": "772-204-4142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "JENNA",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-10",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW22054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anil K Goyal, MD
• Grace Therapies
• Grace Therapies, LLC
• Grace Wellness Center LLC
• Summer Smith Gragg, MSW
• Melanie R Graham, PMHNP-BC
• Maria Jose Granados Frias
• Loretta Grande, RMHC
• Aisha Grant, PHARMD
• Samyia Grant

• Clinical Social Worker in Fort Pierce, FL
• Providers in Fort Pierce, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; 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.