Provider Demographics
NPI:1831307743
Name:GRUMMON, KATHY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:L
Last Name:GRUMMON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HORSESHOE HILL RD
Mailing Address - Street 2:
Mailing Address - City:POUND RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10576-1636
Mailing Address - Country:US
Mailing Address - Phone:914-764-0109
Mailing Address - Fax:
Practice Address - Street 1:9 EDGEMONT RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-1503
Practice Address - Country:US
Practice Address - Phone:914-232-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012804103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV03861Medicare ID - Type Unspecified