Ellen Miriam Grunblatt, MD, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

XL3022 Issued in ME

Practice address

672 Wilton Rd
Farmington, ME 04938-6138

Phone

(207) 778-5792

NPI assigned

Sep 29, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586131200000",
    "number": "1114019759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "672 WILTON RD",
            "city": "FARMINGTON",
            "state": "ME",
            "postal_code": "049386138",
            "telephone_number": "207-778-5792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "672 WILTON RD",
            "city": "FARMINGTON",
            "state": "ME",
            "postal_code": "049386138",
            "telephone_number": "207-778-5792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUNBLATT",
        "first_name": "ELLEN",
        "middle_name": "MIRIAM",
        "credential": "MD, LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-29",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ME",
            "license": "XL3022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vicky Gerstenberger, RN
• Kimberly K Gooch, MD
• Stephen J Goss, D.O.
• Sarah Dehaan Gray, MD
• Julie D Grosvenor, MD
• Eric V Gunther, M.D.
• Mary Andrea Hall, LICSW, LCSW
• Deborah J Hamilton, M.D.
• Paula Hammerick, D.M.D.
• Kathy Hammond, PT

• Professional Counselor in Farmington, ME
• Providers in Farmington, ME by specialty
• Professional Counselor in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.