Active NPI
Eileen Grudier, LCSW
- Clinical Social Worker
- Niantic, CT
National Provider Identifier
1144653668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 008647
- Practice address
- 461 Main St
Niantic, CT 06357-3103 - Phone
- (860) 710-6465
- NPI assigned
- Aug 20, 2013
- Last updated
- Sep 12, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 008647 | CT | Primary |
Addresses
Primary practice location
461 Main St
Niantic, CT 06357-3103
Mailing address
461 Main St
Niantic, CT 06357-3103
Phone (860) 710-6465
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008647 | CT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568246400000",
"number": "1144653668",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "461 MAIN ST",
"city": "NIANTIC",
"state": "CT",
"postal_code": "063573103",
"telephone_number": "860-710-6465"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "461 MAIN ST",
"city": "NIANTIC",
"state": "CT",
"postal_code": "063573103",
"telephone_number": "860-710-6465"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRUDIER",
"first_name": "EILEEN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-20",
"last_updated": "2019-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "008647",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niantic, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.