=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871970038
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT GRATTON PHD LCSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2015
-----------------------------------------------------
Last Update Date | 04/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 MIDDLESEX AVE
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06412-1308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-245-0345
-----------------------------------------------------
Fax | 860-526-5381
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37 MIDDLESEX AVE
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06412-1308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-245-0345
-----------------------------------------------------
Fax | 860-526-5381
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROBERT THOMAS GRATTON
-----------------------------------------------------
Credential | PH.D. LCSW
-----------------------------------------------------
Telephone | 203-245-0345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 000322
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------