Individual
MS. EBONESHA M GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
180 RIDGEWAY AVE, ROCHESTER, NY 14615-3636
(585) 794-0641
Mailing address
10 EAGLE ST, ROCHESTER, NY 14608-2230
(585) 794-0641
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
083851-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
083851-1
LICENSED SOCIAL WORKER
NY
Enumeration date
09/10/2012
Last updated
09/10/2012
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