Provider Demographics
NPI:1578365292
Name:GRAHAM, MARK ALASTAIR (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALASTAIR
Last Name:GRAHAM
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 S KINGMAN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2611
Mailing Address - Country:US
Mailing Address - Phone:973-270-5976
Mailing Address - Fax:
Practice Address - Street 1:37 S KINGMAN RD
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2611
Practice Address - Country:US
Practice Address - Phone:973-270-5976
Practice Address - Fax:973-270-5976
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SCO54846001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical