Healthcare Provider Details

I. General information

NPI: 1104176973
Provider Name (Legal Business Name): ELIZABETH ANNE GRUENFELD ED.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1269 BEACON STREET TRAUMA CENTER AT JRI
BROOKLINE MA
02446
US

IV. Provider business mailing address

1 WARREN COURT
SALEM MA
01970
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-1303
  • Fax:
Mailing address:
  • Phone: 206-334-6234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: