Provider Demographics
NPI:1235608811
Name:GREY BROOK ASSOCIATES, LLC
Entity Type:Organization
Organization Name:GREY BROOK ASSOCIATES, LLC
Other - Org Name:SHORELINE SPECTRUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:STOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-231-4588
Mailing Address - Street 1:310 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2121
Mailing Address - Country:US
Mailing Address - Phone:203-231-4588
Mailing Address - Fax:
Practice Address - Street 1:377 MAIN STREET
Practice Address - Street 2:C/O SHORELINE CENTER
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06483
Practice Address - Country:US
Practice Address - Phone:203-231-4588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty