Provider Demographics
NPI:1245400977
Name:GRUNGLASSE, MARIA ESMERALDA (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:ESMERALDA
Last Name:GRUNGLASSE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 FALMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1841
Mailing Address - Country:US
Mailing Address - Phone:207-205-5819
Mailing Address - Fax:207-205-5820
Practice Address - Street 1:16 WHITEHEAD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04108-1316
Practice Address - Country:US
Practice Address - Phone:207-205-5819
Practice Address - Fax:207-205-5820
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2017-02-23
Deactivation Date:2016-06-07
Deactivation Code:
Reactivation Date:2016-08-22
Provider Licenses
StateLicense IDTaxonomies
FLLMHC8891101YM0800X
MELCPC# CC4520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health