Healthcare Provider Details

I. General information

NPI: 1104332121
Provider Name (Legal Business Name): GABRIEL GROCHOWSKI LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 3RD ST
PROVIDENCE RI
02906-2729
US

IV. Provider business mailing address

72 3RD ST
PROVIDENCE RI
02906-2729
US

V. Phone/Fax

Practice location:
  • Phone: 570-499-0674
  • Fax:
Mailing address:
  • Phone: 570-499-0674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMHC01168
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: