Provider Demographics
NPI:1851485619
Name:GRANT-HALL, ROBIN A (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:A
Last Name:GRANT-HALL
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 1:19 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2135
Mailing Address - Country:US
Mailing Address - Phone:860-659-8765
Mailing Address - Fax:860-652-8584
Practice Address - Street 1:19 CONCORD ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2135
Practice Address - Country:US
Practice Address - Phone:860-659-8765
Practice Address - Fax:860-652-8584
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001578103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical