Active NPI
Deshea Yvonne Graham
- Clinical Social Worker
- Charlottesville, VA
National Provider Identifier
1508225699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904010788
- Practice address
- 1 Boars Head LN
Charlottesville, VA 22903-4681 - Phone
- (434) 202-4155
- NPI assigned
- Feb 17, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 091318 | NY | |
| Clinical Social Worker | 1041C0700X | 0904010788 | VA | Primary |
Addresses
Primary practice location
1 Boars Head LN
Charlottesville, VA 22903-4681
Mailing address
156 Lexie LN
Palmyra, VA 22963-2078
Phone (703) 475-6179
Other practice location 1
2026 3rd Ave
apt 3f
New York, NY 10029-2891
Phone (301) 880-6000
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00355940 | Medicaid | NY | |
| 6776040 | Other | VA | AETNA |
| 697861 | Other | VA | ANTHEM BLUE CROSS BLUE SHIELD |
| WVE061 | Other | NY | MEDICARE # |
| 1285628552 | Other | NY | AGENCY |
| 14343049 | Other | VA | CIGNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0904010788 | VA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672358400000",
"number": "1508225699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "156 LEXIE LN",
"city": "PALMYRA",
"state": "VA",
"postal_code": "229632078",
"telephone_number": "703-475-6179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BOARS HEAD LN",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "229034681",
"telephone_number": "434-202-4155"
}
],
"practiceLocations": [
{
"address_1": "2026 3rd Ave",
"address_2": "apt 3f",
"address_purpose": "LOCATION",
"city": "New York",
"state": "NY",
"postal_code": "100292891",
"country_code": "US",
"telephone_number": "301-880-6000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GRAHAM",
"first_name": "DESHEA",
"middle_name": "YVONNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-17",
"last_updated": "2022-12-30",
"certification_date": "2022-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "091318",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904010788",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00355940",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "6776040",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS BLUE SHIELD",
"identifier": "697861",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE #",
"identifier": "WVE061",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AGENCY",
"identifier": "1285628552",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "14343049",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlottesville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.