Individual
ELLEN MIRIAM GRUNBLATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD, LCPC
Contact information
Practice address
672 WILTON RD, FARMINGTON, ME 04938-6138
(207) 778-5792
Mailing address
672 WILTON RD, FARMINGTON, ME 04938-6138
(207) 778-5792
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
XL3022
ME
Other
Enumeration date
09/29/2006
Last updated
04/06/2020
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