Provider Demographics
NPI:1629046487
Name:GRUNBAUM, MADELINE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:
Last Name:GRUNBAUM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980-990 WASHINGTON ST
Mailing Address - Street 2:ADFILIARE PSYCHOTHERAPY INC STE 209
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026
Mailing Address - Country:US
Mailing Address - Phone:781-329-4774
Mailing Address - Fax:781-329-9153
Practice Address - Street 1:980-990 WASHINGTON ST
Practice Address - Street 2:ADFILIARE PSYCHOTHERAPY INC STE 209
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026
Practice Address - Country:US
Practice Address - Phone:781-329-4774
Practice Address - Fax:781-329-9153
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103795NASW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical