1235201484 NPI number — MRS. CAITLIN BETH GROSSI LMHC

Table of content: MRS. CAITLIN BETH GROSSI LMHC (NPI 1235201484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235201484 NPI number — MRS. CAITLIN BETH GROSSI LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROSSI
Provider First Name:
CAITLIN
Provider Middle Name:
BETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235201484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 FOREST HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPDEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01036-9712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-210-1893
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
167 DWIGHT RD
Provider Second Line Business Practice Location Address:
SUITE 102A
Provider Business Practice Location Address City Name:
LONGMEADOW
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01106-1674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-210-1893
Provider Business Practice Location Address Fax Number:
508-437-0239
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  5787 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1235201484 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com