Basic Information
| Provider Information | |||||||||
| NPI: | 1730325531 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRUNBLATT PSYCHOLOGY AND COUNSELING OFFICES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 GREEN ST | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124014422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453313001 | ||||||||
| FaxNumber: | 8453354600 | ||||||||
| Practice Location | |||||||||
| Address1: | 124 GREEN ST | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124014422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453313001 | ||||||||
| FaxNumber: | 8453354600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2008 | ||||||||
| LastUpdateDate: | 06/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | GRUNBLATT | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8453313001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.