Marvin Darnell Graddy

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

License

101YA0400X Issued in CA

Practice address

1320 Rockspring Way
Antioch, CA 94531-8397

Phone

(925) 334-9906

NPI assigned

Mar 12, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615507200000",
    "number": "1144805011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3707 SUNSET LN",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945096101",
            "telephone_number": "925-522-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 ROCKSPRING WAY",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945318397",
            "telephone_number": "925-334-9906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRADDY",
        "first_name": "MARVIN",
        "middle_name": "DARNELL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-12",
        "last_updated": "2021-03-12",
        "certification_date": "2021-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "101YA0400X",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "101YA0400X",
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "101YA0400X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5VE8-FC6-UP53",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "OTHER",
            "affiliation": "N",
            "endpointDescription": "OTHER",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "OTHER",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "OTHER",
            "address_1": "1320 Rockspring Way",
            "city": "Antioch",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945318397",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "OTHER",
            "affiliation": "N",
            "endpointDescription": "OTHER",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "OTHER",
            "address_1": "1320 Rockspring Way",
            "city": "Antioch",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945318397",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Psychologist in Antioch, CA
• Providers in Antioch, CA by specialty
• Addiction (Substance Use Disorder) Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.