Organization
NICOLE GRAHAM PHD PA
Active
Organization
NICOLE GRAHAM PHD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE GRAHAM PHD (PRESIDENT)
(954) 365-5366
Entity
Organization
Contact information
Practice address
12 SE 7TH ST STE 705, FORT LAUDERDALE, FL 33301-3469
(954) 365-5366
Mailing address
12 SE 7TH ST STE 705, FORT LAUDERDALE, FL 33301-3469
(954) 365-5366
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
103TC0700X
Clinical Psychologist
—
—
103TF0200X
Forensic Psychologist
—
—
Other
Enumeration date
09/18/2020
Last updated
12/02/2024
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