Healthcare Provider Details

I. General information

NPI: 1649965146
Provider Name (Legal Business Name): MARIA GARRITY GRINDLE M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5138 SHELBURNE RD STE 125138
SHELBURNE VT
05482-6698
US

IV. Provider business mailing address

86 LAKE ST
BURLINGTON VT
05401-5297
US

V. Phone/Fax

Practice location:
  • Phone: 802-865-3450
  • Fax:
Mailing address:
  • Phone: 802-865-3450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097.0125812
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: