Healthcare Provider Details

I. General information

NPI: 1053020065
Provider Name (Legal Business Name): ERICH K GROMMET PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 CRESTWOOD BLVD
BIRMINGHAM AL
35212-4203
US

IV. Provider business mailing address

6001 CRESTWOOD BLVD
BIRMINGHAM AL
35212-4203
US

V. Phone/Fax

Practice location:
  • Phone: 205-316-9939
  • Fax: 205-961-3007
Mailing address:
  • Phone: 205-316-9939
  • Fax: 205-961-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPS2448
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number023148
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number2289
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2018-003
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: