Provider Demographics
NPI:1104171271
Name:GRUMBINE, ANDREA BETH (MS, LCAT)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:BETH
Last Name:GRUMBINE
Suffix:
Gender:F
Credentials:MS, LCAT
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Mailing Address - Street 1:15 HIGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-2911
Mailing Address - Country:US
Mailing Address - Phone:845-255-8830
Mailing Address - Fax:
Practice Address - Street 1:15 HIGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-2911
Practice Address - Country:US
Practice Address - Phone:845-255-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000084-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist