Provider Demographics
NPI:1730325531
Name:GRUNBLATT PSYCHOLOGY AND COUNSELING OFFICES, P.C.
Entity type:Organization
Organization Name:GRUNBLATT PSYCHOLOGY AND COUNSELING OFFICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:845-331-3001
Mailing Address - Street 1:124 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4422
Mailing Address - Country:US
Mailing Address - Phone:845-331-3001
Mailing Address - Fax:845-335-4600
Practice Address - Street 1:124 GREEN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4422
Practice Address - Country:US
Practice Address - Phone:845-331-3001
Practice Address - Fax:845-335-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100047665Medicare PIN