NPIMap

Individual provider Active NPI

Elizabeth Anne Gravallese-Anderson, PSY.D.

  • Clinical Child & Adolescent Psychologist
  • Cherry Hill, NJ
National Provider Identifier
1952736431
Registry record updated May 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
PS019243 Issued in PA
Practice address
325 Marlton Pike E
Cherry Hill, NJ 08034
Phone
(856) 309-8508
Fax
(856) 309-8556
NPI assigned
Sep 4, 2013
Last updated
May 29, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 35SI00574600 NJ
Clinical Child & Adolescent Psychologist 103TC2200X PS019243 PA Primary

Addresses

Primary practice location

325 Marlton Pike E
Cherry Hill, NJ 08034

Mailing address

PO Box 191
Rockland, DE 19732-0191
Phone (302) 651-4200

Other practice location 1

42 E Laurel Rd Ste 1100
Stratford, NJ 08084-1354
Phone (856) 566-7036

Other practice location 2

42 E Laurel Rd Ste 1100
Stratford, NJ 08084-1354
Phone (856) 566-7036

Other names 1

  • Elizabeth Anne Gravallese Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
35SI00574600NJMDClinical Child & Adolescent Psychologist
PS019243PAMDClinical Child & Adolescent Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Rowansom Cares Institute Psychologist Past Accepting new patients
Rowansom Cares Institute Psychologist Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716940800000",
    "number": "1952736431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191",
            "city": "ROCKLAND",
            "state": "DE",
            "postal_code": "197320191",
            "telephone_number": "302-651-4200",
            "fax_number": "302-651-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 MARLTON PIKE E",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "08034",
            "telephone_number": "856-309-8508",
            "fax_number": "856-309-8556"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "42 E Laurel Rd Ste 1100",
            "address_purpose": "LOCATION",
            "city": "Stratford",
            "state": "NJ",
            "postal_code": "080841354",
            "country_code": "US",
            "telephone_number": "856-566-7036",
            "fax_number": "856-566-6108",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "42 E Laurel Rd Ste 1100",
            "address_purpose": "LOCATION",
            "city": "Stratford",
            "state": "NJ",
            "postal_code": "080841354",
            "country_code": "US",
            "telephone_number": "856-566-7036",
            "fax_number": "856-566-6108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAVALLESE-ANDERSON",
        "first_name": "ELIZABETH",
        "middle_name": "ANNE",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-04",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NJ",
            "license": "35SI00574600",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "PA",
            "license": "PS019243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "GRAVALLESE",
            "middle_name": "ANNE",
            "credential": "PSYD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cherry Hill, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; 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.