Healthcare Provider Details

I. General information

NPI: 1083950471
Provider Name (Legal Business Name): PAUL HENRY GROENEWAL PSY. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 FRANKLIN AVE FLOOR 2 (GROENEWAL)
WYCKOFF NJ
07481-1980
US

IV. Provider business mailing address

356 FRANKLIN AVE FLOOR 2 (GROENEWAL)
WYCKOFF NJ
07481-1980
US

V. Phone/Fax

Practice location:
  • Phone: 551-206-2479
  • Fax:
Mailing address:
  • Phone: 551-206-2479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019231
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35S100494500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: