Provider Demographics
NPI:1053023408
Name:GRAHAM, JORDANA (LMSW)
Entity type:Individual
Prefix:
First Name:JORDANA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MUSTARD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-6980
Mailing Address - Country:US
Mailing Address - Phone:585-481-1041
Mailing Address - Fax:585-654-1542
Practice Address - Street 1:1 MUSTARD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-6980
Practice Address - Country:US
Practice Address - Phone:585-481-1041
Practice Address - Fax:585-654-1542
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102919104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker