Provider Demographics
NPI:1114755030
Name:GRENIER, STEVEN TYLER (LCDP)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:TYLER
Last Name:GRENIER
Suffix:
Gender:M
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CURRY RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-2218
Mailing Address - Country:US
Mailing Address - Phone:401-209-5663
Mailing Address - Fax:
Practice Address - Street 1:1990 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-2404
Practice Address - Country:US
Practice Address - Phone:401-781-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00993101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)