Individual
LA RISA GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
6143 186TH ST STE 599, FRESH MEADOWS, NY 11365-2710
(551) 209-3506
(609) 363-1347
Mailing address
6143 SPRINGFIELD BLVD UNIT 640221, BAYSIDE, NY 11364-3480
(347) 753-8833
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
794434
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
26NJ14844200
NJ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
404814
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
01/11/2013
Last updated
09/07/2025
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