| Nicole Graham Phd Pa | |
|
11760 W Sample Rd Ste 103 Coral Springs FL 33065-3199 | |
| (954) 766-8826 | |
| Not Available |
| Full Name | Nicole Graham Phd Pa |
|---|---|
| Speciality | Psychologist |
| Location | 11760 W Sample Rd Ste 103, Coral Springs, Florida |
| Authorized Official Name and Position | Nicole Graham (PRESIDENT) |
| Authorized Official Contact | 9542927456 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicole Graham Phd Pa 1600 E Sunrise Blvd Apt 3411 Fort Lauderdale FL 33304-2377 Ph: (954) 292-7456 | Nicole Graham Phd Pa 11760 W Sample Rd Ste 103 Coral Springs FL 33065-3199 Ph: (954) 766-8826 |
| NPI Number | 1427664176 |
|---|---|
| Provider Enumeration Date | 09/18/2020 |
| Last Update Date | 09/18/2020 |
| Certification Date | 09/18/2020 |
| Medicare PECOS PAC ID | 9335569284 |
|---|---|
| Medicare Enrollment ID | O20201015001266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427664176 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Nicole Graham |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568742435 PECOS PAC ID: 7012337967 Enrollment ID: I20201015001577 |
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