Provider Demographics
NPI:1649075375
Name:GRAVES, ANTHONY (MFA, LP)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:GRAVES
Suffix:
Gender:
Credentials:MFA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 5TH AVE RM 1109
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6655
Mailing Address - Country:US
Mailing Address - Phone:718-490-2646
Mailing Address - Fax:
Practice Address - Street 1:303 5TH AVE RM 1109
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6655
Practice Address - Country:US
Practice Address - Phone:718-490-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001242-01102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst