Healthcare Provider Details

I. General information

NPI: 1871415240
Provider Name (Legal Business Name): AMBERLYN GRASSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBERLYN MARIE NEWTON

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 LITTLE CITY RD
HIGGANUM CT
06441-4323
US

IV. Provider business mailing address

7132 TOWN RDG
MIDDLETOWN CT
06457-6548
US

V. Phone/Fax

Practice location:
  • Phone: 978-852-6758
  • Fax:
Mailing address:
  • Phone: 978-852-6758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10213
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9651
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: