Provider Demographics
NPI:1255606406
Name:ANDREA GRUNBLATT PSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:ANDREA GRUNBLATT PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-418-5885
Mailing Address - Street 1:124 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4422
Mailing Address - Country:US
Mailing Address - Phone:845-418-8558
Mailing Address - Fax:845-335-4600
Practice Address - Street 1:124 GREEN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4422
Practice Address - Country:US
Practice Address - Phone:845-418-8558
Practice Address - Fax:845-335-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty