Nicole Graham PHD PA

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

Legal business name

NICOLE GRAHAM PHD PA

Practice address

12 SE 7TH St Ste 705
Fort Lauderdale, FL 33301-3469

Phone

(954) 365-5366

NPI assigned

Sep 18, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Nicole Graham, PHDNPI 1568742435

Title

President

Phone

(954) 365-5366

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicole Graham, PH.D.

  • Clinical Neuropsychologist
  • Fort Lauderdale, FL
  • NPI 1568742435
  Medicare reassignment Authorized official
• Justine De la Rosa Decastro, M.D.

  • Family Medicine Physician
  • Mount Pleasant, SC
  • NPI 1194936831
  NPD

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

{
    "created_epoch": "1600387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733097600000",
    "number": "1427664176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 SE 7TH ST STE 705",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333013469",
            "telephone_number": "954-365-5366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 SE 7TH ST STE 705",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333013469",
            "telephone_number": "954-365-5366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLE GRAHAM PHD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-18",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-365-5366",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Forensic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicklaus Children's Pediatric Specialists, LLC (Nicklaus Children's Specialty Care Center at Fort Lauderdale)
• Nicmoy Home Care Services LLC
• Anna Jane Nicolas, PA-C
• Rose Rachelle L Nicolas
• Marylou Kneeland Nicolazzo
• Nicole Lilienthal, Ms, CCC-SLP, PA
• Nicolle Deleo LMHC PSYD PA
• Sasha Nicolle
• Alan L Niederman, MD
• Ashly Nielsen, CST

• Clinical Neuropsychologist in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Clinical Neuropsychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.