Provider Demographics
NPI:1437846268
Name:GRAHAM, JOEL M (CASAC-T CRPA)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:M
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:CASAC-T CRPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-2116
Mailing Address - Country:US
Mailing Address - Phone:716-842-0440
Mailing Address - Fax:
Practice Address - Street 1:951 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2116
Practice Address - Country:US
Practice Address - Phone:716-842-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-P-5394175T00000X
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist