Individual
DR. ANDREW MOYER GRUNEBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
999 SUMMER ST, SUITE 200, STAMFORD, CT 06905-5546
(203) 324-9712
(203) 357-9030
Mailing address
5 SPOKE DR, WOODBRIDGE, CT 06525-1132
(203) 393-0817
(203) 357-9030
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
001760
CT
103TC0700X
Clinical Psychologist
Primary
001760
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060001760CT01
ANTHEM BLUE CROSS ID
CT
01
—
4309291
AETNA PIN NUMBER
CT
01
—
6893902
GHI-VALUEOPTIONS ID
CT
Enumeration date
02/02/2007
Last updated
10/05/2010
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