Provider Demographics
NPI:1538380480
Name:ABLON, GRIDTH (PHD)
Entity type:Individual
Prefix:DR
First Name:GRIDTH
Middle Name:
Last Name:ABLON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467
Mailing Address - Country:US
Mailing Address - Phone:617-734-5371
Mailing Address - Fax:617-277-0608
Practice Address - Street 1:62 CHESTNUT HILL RD
Practice Address - Street 2:
Practice Address - City:CHESNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467
Practice Address - Country:US
Practice Address - Phone:617-734-5371
Practice Address - Fax:617-277-0608
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA442103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical