Provider Demographics
NPI:1073813804
Name:GRYCZKOWSKI, MICHELLE R (PHD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:GRYCZKOWSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 WOODMONT AVE STE 1101
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-7059
Mailing Address - Country:US
Mailing Address - Phone:301-304-6116
Mailing Address - Fax:
Practice Address - Street 1:7910 WOODMONT AVE STE 1101
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-7059
Practice Address - Country:US
Practice Address - Phone:301-304-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3267103TB0200X
MD05840103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral