Provider Demographics
NPI:1477685493
Name:GRUSING, MELVIN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:GRUSING
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7992 S VINCENNES WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3333
Mailing Address - Country:US
Mailing Address - Phone:303-773-3293
Mailing Address - Fax:
Practice Address - Street 1:3900 E MEXICO AVE STE 612
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3943
Practice Address - Country:US
Practice Address - Phone:303-691-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8765051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91666Medicare ID - Type Unspecified