Provider Demographics
NPI:1205840246
Name:GROTE, DOUGLAS V (LICSW CADAC-II)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:V
Last Name:GROTE
Suffix:
Gender:M
Credentials:LICSW CADAC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2016
Mailing Address - Country:US
Mailing Address - Phone:413-773-8155
Mailing Address - Fax:
Practice Address - Street 1:15 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2912
Practice Address - Country:US
Practice Address - Phone:413-774-2704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0893AL101YA0400X
MA10308681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1857380Medicaid
MAP21111Medicare ID - Type Unspecified