Provider Demographics
NPI:1316182363
Name:GRUDER, ALLISON (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:GRUDER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-1610
Mailing Address - Country:US
Mailing Address - Phone:203-259-0089
Mailing Address - Fax:
Practice Address - Street 1:261 COVENTRY LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-1610
Practice Address - Country:US
Practice Address - Phone:203-259-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist