Individual
NICOLE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
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
PY10889
FL
103T00000X
Psychologist
PY10889
FL
103TC0700X
Clinical Psychologist
PY10889
FL
103TF0200X
Forensic Psychologist
PY10889
FL
Other
Enumeration date
08/24/2011
Last updated
12/02/2024
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