Organization
ALISTAIR GRAHAM PSYCHOTHERAPY LCSW PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL MCKENNA (DELEGATED OFFICIAL)
(917) 848-2985
Entity
Organization
Contact information
Practice address
113-15 UNIVERSITY PLACE, FLOOR 8, ROOM 8, NEW YORK, NY 10003
(917) 267-0696
Mailing address
504 GRAND ST APT H42, NEW YORK, NY 10002-4136
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A300114868
MEDICARE
NY
Enumeration date
06/04/2019
Last updated
06/04/2019
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