Provider Demographics
NPI:1104945229
Name:GRUENER, CLINTON CHRISTOPHER (MA)
Entity type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:CHRISTOPHER
Last Name:GRUENER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 LANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1960
Mailing Address - Country:US
Mailing Address - Phone:617-965-6552
Mailing Address - Fax:
Practice Address - Street 1:72 LANGLEY RD
Practice Address - Street 2:
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-1960
Practice Address - Country:US
Practice Address - Phone:617-965-6552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC #1286101YM0800X
MALMFT #646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM 0679OtherBLUE CROSS PROVIDER #