Provider Demographics
NPI:1932504214
Name:GRUBISSICH, LUCIANO MARTIN (MD, PSYA)
Entity Type:Individual
Prefix:DR
First Name:LUCIANO
Middle Name:MARTIN
Last Name:GRUBISSICH
Suffix:
Gender:M
Credentials:MD, PSYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 POND AVE APT 701
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7118
Mailing Address - Country:US
Mailing Address - Phone:857-891-7267
Mailing Address - Fax:
Practice Address - Street 1:99 POND AVE APT 701
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7118
Practice Address - Country:US
Practice Address - Phone:857-891-7267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health