Provider Demographics
NPI:1528275989
Name:GRIX, MAUREEN CLAIRE (PHD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:CLAIRE
Last Name:GRIX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 FRANKLIN AVENUE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5801
Mailing Address - Country:US
Mailing Address - Phone:516-746-3691
Mailing Address - Fax:516-294-9057
Practice Address - Street 1:520 FRANKLIN AVENUE
Practice Address - Street 2:SUITE 211
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5801
Practice Address - Country:US
Practice Address - Phone:516-746-3691
Practice Address - Fax:516-294-9057
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014284103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVL6061Medicare ID - Type Unspecified
NYP52002Medicare UPIN