Provider Demographics
NPI:1760455877
Name:GRONDIN, PATRICIA A (LCMHC, MS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:GRONDIN
Suffix:
Gender:F
Credentials:LCMHC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NH
Mailing Address - Zip Code:03583-6851
Mailing Address - Country:US
Mailing Address - Phone:603-444-6465
Mailing Address - Fax:603-444-6233
Practice Address - Street 1:229 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4100
Practice Address - Country:US
Practice Address - Phone:603-444-6465
Practice Address - Fax:603-444-6233
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30424895Medicaid