Provider Demographics
NPI:1659458495
Name:GRUMBINE, DONALD LEON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LEON
Last Name:GRUMBINE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HIGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-2911
Mailing Address - Country:US
Mailing Address - Phone:845-255-8830
Mailing Address - Fax:
Practice Address - Street 1:15 HIGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-2911
Practice Address - Country:US
Practice Address - Phone:845-255-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR020967-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN17211Medicare ID - Type Unspecified