Provider Demographics
NPI:1326471665
Name:GRUNDLEGER, ALEXANDRA B (PHD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:B
Last Name:GRUNDLEGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 SUMMIT LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-1417
Mailing Address - Country:US
Mailing Address - Phone:917-636-0589
Mailing Address - Fax:
Practice Address - Street 1:1331 SUMMIT LN
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-1417
Practice Address - Country:US
Practice Address - Phone:917-636-0589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI0064300103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical