Provider Demographics
NPI:1114941242
Name:GROLEAU, PAUL E (MED)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:E
Last Name:GROLEAU
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 ELM ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1217
Mailing Address - Country:US
Mailing Address - Phone:603-625-8588
Mailing Address - Fax:603-218-6514
Practice Address - Street 1:1650 ELM ST
Practice Address - Street 2:SUITE 404
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1217
Practice Address - Country:US
Practice Address - Phone:603-625-8588
Practice Address - Fax:603-218-6514
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4101YM0800X
NH48101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30006921Medicaid