Donna S. Grisham, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

000424 Issued in CT

Practice address

553 Portland Cobalt Rd
Portland, CT 06480-1968

Phone

(860) 342-0760

Fax

(860) 342-4226

NPI assigned

Jun 3, 2006

Sex

Female

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Town of North Haven Community Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • North Haven, CT
  • NPI 1164513388

  CT

  Medicare reassignment NPD
• Town of North Haven

  • Land Ambulance
  • North Haven, CT
  • NPI 1154836450
  NPD

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 14, 2011.

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310601600000",
    "number": "1508804352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 PORTLAND COBALT RD",
            "city": "PORTLAND",
            "state": "CT",
            "postal_code": "064801968",
            "telephone_number": "860-342-0760",
            "fax_number": "860-342-4226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "553 PORTLAND COBALT RD",
            "city": "PORTLAND",
            "state": "CT",
            "postal_code": "064801968",
            "telephone_number": "860-342-0760",
            "fax_number": "860-342-4226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISHAM",
        "first_name": "DONNA",
        "middle_name": "S.",
        "name_prefix": "Mrs.",
        "credential": "LADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-03",
        "last_updated": "2011-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CT",
            "license": "000424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie S. Dudek, LPC
• Melissa A Fazzolari, APRN
• Morgan Bryant Feshler
• Yiannis Zannis Gazis, DDS
• Peter Gletzakos, DMD
• Wendy Griswold, APRN
• Susan Mary Gubilee, MS, MSW
• Linda Pantano Hassett, OTR/L
• Deborah B. Heilman, MSPT
• Prakash V Huded, MD

• All providers in Portland, CT
• Addiction (Substance Use Disorder) Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2011; 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.