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General NPI Number Information
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NPI Number | 1245205053
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Entity Type | Individual
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Provider Name | LYNN RUTH GRUSH MD
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Gender | Female
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 08/13/2009
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Provider Practice Location Address
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Address Line | 1340 CENTRE ST STE 204
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City | NEWTON CENTER
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State | MA
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Zip | 02459
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Country | US
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Telephone | 617-795-7130
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Fax | 617-795-0953
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Provider Business Mailing Address
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Address Line | 1340 CENTRE ST STE 204
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City | NEWTON CENTRE
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State | MA
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Zip | 02459-2453
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Country | US
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Telephone | 617-795-7130
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Fax | 617-795-0953
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 76631
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 76631
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License Number State | MA
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