Provider Demographics
NPI:1144371972
Name:GRUNDT, ADAM MATTHEW (PHD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:MATTHEW
Last Name:GRUNDT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LOOMIS STREET
Mailing Address - Street 2:#1
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602
Mailing Address - Country:US
Mailing Address - Phone:763-509-3818
Mailing Address - Fax:763-559-0149
Practice Address - Street 1:132 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843
Practice Address - Country:US
Practice Address - Phone:802-683-7533
Practice Address - Fax:763-559-0149
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4353103TC0700X
VT048.0093365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical