Provider Demographics
NPI:1982769667
Name:GREBEL, MARTIN (PHD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:GREBEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 KINGSBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3407
Mailing Address - Country:US
Mailing Address - Phone:203-605-7591
Mailing Address - Fax:
Practice Address - Street 1:21 KINGSBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3407
Practice Address - Country:US
Practice Address - Phone:203-605-7591
Practice Address - Fax:860-443-5990
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-24
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000433103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical