Individual
MRS. PHYLLIS GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
TEACHER
Contact information
Practice address
100 DEKRUIF PLACE, #22J, BRONX, NY 10475-2419
(646) 408-6497
(718) 671-7976
Mailing address
100 DEKRUIF PLACE, 22J, BRONX, NY 10475-2419
(646) 408-6497
(718) 671-7976
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
20-4097009
NY
Other
Enumeration date
11/05/2008
Last updated
11/05/2008
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