MEDICARE: DR. JAMES A GRUBMAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	7419	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W05794	OTHER	MA	BCBSMA

General Provider Information

NPI Number	:	1013901651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES A GRUBMAN PH.D.

Provider Business Mailing Address
First Line	:	356 MONTAGUE CITY RD
Second Line	:	SUITE 100
City	:	TURNERS FALLS
State	:	MA
Zip	:	01376-1830
Country	:	US
Telephone Number	:	413-775-0557
Fax Number	:

Provider Business Practice Location Address
First Line	:	356 MONTAGUE CITY RD
Second Line	:	SUITE 100
City	:	TURNERS FALLS
State	:	MA
Zip	:	01376-1830
Country	:	US
Telephone Number	:	413-775-0557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	06/30/2010

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