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Organization
ST. ANNE'S MEDICAL SERVICES
Active
Organization
ST. ANNE'S MEDICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEANINE E. GRAVES OD (ADMINISTRATOR)
(201) 310-6947
Entity
Organization
Contact information
Practice address
64 NAGLE AVE, NEW YORK, NY 10040-1406
(201) 310-6947
(201) 796-2205
Mailing address
10 AUSTIN PL, CLIFTON, NJ 07014-1901
(201) 310-6947
(201) 796-2205
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
NULL
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
Other
Enumeration date
03/21/2017
Last updated
03/21/2017
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