Provider Demographics
NPI:1386432292
Name:GRAVES, NAKISHA
Entity type:Individual
Prefix:
First Name:NAKISHA
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEDROW
Mailing Address - State:NY
Mailing Address - Zip Code:13120-1243
Mailing Address - Country:US
Mailing Address - Phone:315-807-9405
Mailing Address - Fax:
Practice Address - Street 1:104 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:NEDROW
Practice Address - State:NY
Practice Address - Zip Code:13120-1243
Practice Address - Country:US
Practice Address - Phone:315-807-9405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126463-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker