Individual
MR. BADRI ANTHONY GRAVESANDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
75 VANDERBILT AVE, STATEN ISLAND, NY 10304-2604
(718) 818-5638
Mailing address
75 VANDERBILT AVE, STATEN ISLAND, NY 10304-2604
(718) 818-5638
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
003899
NY
Other
Enumeration date
10/13/2010
Last updated
10/13/2010
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