John W Graves, M.ED.,M.S., M.S.
Individual provider Active NPI Clinical Child & Adolescent Psychologist · Yeadon, PA
NPI 1922385236 · NPPES record last updated Nov 15, 2011
Key facts
- NPI
- 1922385236
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Child & Adolescent Psychologist 103TC2200X
- License
- 103TC2200X (PA)
- Practice address
- 862 Whitby Ave
Yeadon, PA 19050-3510 - Phone
- (215) 917-4468
- NPI assigned
- Nov 15, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Education, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103TC2200X | PA | MD | Clinical Child & Adolescent Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 103TC2200X | PA | Yes |
Addresses
Primary practice location
862 Whitby Ave
Yeadon, PA 19050-3510
Mailing address
862 Whitby Ave
Yeadon, PA 19050-3510
Phone (215) 917-4468
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All providers in Yeadon, PA · Clinical Child & Adolescent Psychologist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.