Active NPI
Gustavo Rafael Grodnitzky, PH.D.
- Psychologist
- Winston Salem, NC
National Provider Identifier
1043549900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2810
- Practice address
- 736 Mitch Dr
Winston Salem, NC 27104-5126 - Phone
- (336) 659-8058
- NPI assigned
- Dec 23, 2009
- Last updated
- Jan 5, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2810 | NC | Primary |
Addresses
Primary practice location
736 Mitch Dr
Winston Salem, NC 27104-5126
Mailing address
736 Mitch Dr
Winston Salem, NC 27104-5126
Phone (336) 659-8058
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1261526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262649600000",
"number": "1043549900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "736 MITCH DR",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271045126",
"telephone_number": "336-659-8058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "736 MITCH DR",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271045126",
"telephone_number": "336-659-8058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRODNITZKY",
"first_name": "GUSTAVO",
"middle_name": "RAFAEL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-12-23",
"last_updated": "2010-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "2810",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
- Julianne Marie Grissom, OD
- Davyn Griswold, CNM, WHNP
- Alan Townes Grizzard, FNP-C
- Keith Francis Groach, PA-C
- Tyler Groce, O.D.
- Gromeds to Go Transportation Inc
- Gromeds to Go Transportation Inc (GroMeds Cares Group Home)
- Gromeds to Go Transportation Inc
- James Michael Thomas Gross
- Jessica Lynn Gross, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.