Healthcare Provider Details

I. General information

NPI: 1962726620
Provider Name (Legal Business Name): BETH DANIELLE GOLDSTEIN GRUNSCHEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. BETH DANIELLE GOLDSTEIN

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 MEADOW ST FL 1
FAIRFIELD CT
06824-5307
US

IV. Provider business mailing address

411 MEADOW ST FL 1
FAIRFIELD CT
06824-5307
US

V. Phone/Fax

Practice location:
  • Phone: 203-451-3147
  • Fax: 203-292-3389
Mailing address:
  • Phone: 203-451-3147
  • Fax: 203-292-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number314068
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number051105
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number051105
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number314068
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: