Provider Demographics
NPI:1518181114
Name:GRAUSTEIN, GREGORY (LCDP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:GRAUSTEIN
Suffix:
Gender:M
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 CENTRAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CENTRAL FALLS
Mailing Address - State:RI
Mailing Address - Zip Code:02863-2847
Mailing Address - Country:US
Mailing Address - Phone:401-365-6811
Mailing Address - Fax:401-365-6813
Practice Address - Street 1:198 CENTRAL ST # 200
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-2847
Practice Address - Country:US
Practice Address - Phone:401-365-6811
Practice Address - Fax:401-365-6813
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDP00004101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134OtherGROUP NUMBER