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General NPI Number Information
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NPI Number | 1255606406
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Entity Type | Organization
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Legal Business Name | ANDREA GRUNBLATT PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 124 GREEN ST
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City | KINGSTON
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State | NY
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Zip | 12401-4422
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Country | US
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Telephone | 845-418-8558
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Fax | 845-335-4600
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Provider Business Mailing Address
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Address Line | 124 GREEN ST
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City | KINGSTON
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State | NY
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Zip | 12401-4422
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Country | US
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Telephone | 845-418-8558
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Fax | 845-335-4600
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREA GRUNBLATT
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Credential |
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Telephone | 845-418-5885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 016158
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License Number State | NY
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