Provider Demographics
NPI:1083709943
Name:GROHMAN, KERRY KATHLEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:KATHLEEN
Last Name:GROHMAN
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 1:469 WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4648
Mailing Address - Country:US
Mailing Address - Phone:716-833-3827
Mailing Address - Fax:716-833-9710
Practice Address - Street 1:3495 BAILEY AVE
Practice Address - Street 2:VA-WNYHS, 116B
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1129
Practice Address - Country:US
Practice Address - Phone:716-833-3827
Practice Address - Fax:716-833-9710
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015340-1103G00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02407041Medicaid
NYP70018Medicare UPIN
NYDD5724Medicare ID - Type Unspecified