Provider Demographics
NPI:1346591302
Name:GRABOWSKI, MARY SUSAN
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:SUSAN
Last Name:GRABOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SONG BIRD CIR
Mailing Address - Street 2:
Mailing Address - City:FORESTDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02644-1222
Mailing Address - Country:US
Mailing Address - Phone:774-269-0649
Mailing Address - Fax:508-477-9843
Practice Address - Street 1:8 SONG BIRD CIR
Practice Address - Street 2:
Practice Address - City:FORESTDALE
Practice Address - State:MA
Practice Address - Zip Code:02644-1222
Practice Address - Country:US
Practice Address - Phone:774-269-0649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-30
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MA10818103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor