Provider Demographics
NPI:1538496369
Name:GRONDIN, GERARD RENE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:RENE
Last Name:GRONDIN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LAURENCE WAY
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2659
Mailing Address - Country:US
Mailing Address - Phone:207-878-8058
Mailing Address - Fax:
Practice Address - Street 1:14 LAURENCE WAY
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2659
Practice Address - Country:US
Practice Address - Phone:207-878-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMF0000208106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist