Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003366584 |
---|---|
Provider Name | Maisha Graham |
First Address | Brooklyn, NY 11207-1376 |
Second Address | Brooklyn, NY 11207-1376 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2016 |
Last Update Date | 01/05/2017 |