Provider Demographics
NPI:1861763443
Name:GRAHAM, DANIEL ALAN
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALAN
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BICKFORD WAY
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4102
Mailing Address - Country:US
Mailing Address - Phone:978-283-8981
Mailing Address - Fax:
Practice Address - Street 1:1 BICKFORD WAY
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4102
Practice Address - Country:US
Practice Address - Phone:978-283-8981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor