Individual provider Active NPI

Irma Grebel, LCSW

  • Clinical Social Worker
  • Madison, CT
National Provider Identifier
1063577740
Registry record updated Oct 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
000022 Issued in CT
Practice address
21 Kingsbridge Way
Madison, CT 06443-3407
Phone
(860) 558-4447
NPI assigned
Dec 24, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 000022 CT Primary

Addresses

Primary practice location

21 Kingsbridge Way
Madison, CT 06443-3407

Mailing address

21 Kingsbridge Way
Madison, CT 06443-3407
Phone (860) 558-4447

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100823001116 CT Practitioner - Clinical Social Worker 9234253535 Practice locations: New London, CT

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
000022CTMDAdvanced Practice Midwife

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1063577740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 KINGSBRIDGE WAY",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064433407",
            "telephone_number": "860-558-4447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 KINGSBRIDGE WAY",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064433407",
            "telephone_number": "860-558-4447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREBEL",
        "first_name": "IRMA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-24",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "000022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, CT

Sources for this page

Verify at the official NPI Registry.