Individual provider Active NPI

Ebony Graham, MA

  • Professional Counselor
  • Essex, CT
National Provider Identifier
1750844635
Registry record updated Apr 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Practice address
190 Westbrook Rd
Essex, CT 06426-1518
Phone
(860) 767-0147
Fax
(860) 767-0148
NPI assigned
Apr 9, 2019
Last updated
Apr 9, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X Primary

Addresses

Primary practice location

190 Westbrook Rd
Essex, CT 06426-1518

Mailing address

255 Hempstead St
New London, CT 06320-6204
Phone (860) 443-2896

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240503001666 CT Practitioner - Clinical Social Worker 4981044286 Reassigns benefits to 1 organization
I20250702000666 CT Practitioner - Mental Health Counselor 4981044286 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
4962CTMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Clifford W. Beers Guidance Clinic Inc CurrentSince Mar 26, 2024 Accepting new patients
Grow Healthcare Group PA Professional CurrentSince Jun 27, 2025 Accepting new patients

Locations

41 Marne St
Hamden, CT 06514
Phone (203) 691-9383

100 Pearl St
Fl 14
Hartford, CT 06103
Phone (860) 421-6636

93 Edwards St
New Haven, CT 06511
Phone (203) 772-1270

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554768000000",
    "number": "1750844635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 HEMPSTEAD ST",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063206204",
            "telephone_number": "860-443-2896",
            "fax_number": "860-442-5909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 WESTBROOK RD",
            "city": "ESSEX",
            "state": "CT",
            "postal_code": "064261518",
            "telephone_number": "860-767-0147",
            "fax_number": "860-767-0148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "EBONY",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-09",
        "last_updated": "2019-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Essex, CT

Sources for this page

Verify at the official NPI Registry.