Pediatric Psychology of Connecticut, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3139 Issued in CT

Legal business name

PEDIATRIC PSYCHOLOGY OF CONNECTICUT, LLC

Practice address

413 Orange St
Suite 1
New Haven, CT 06511-6424

Phone

(888) 342-6002

Fax

(347) 344-6594

NPI assigned

Apr 9, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Mark Vincent Grudberg, PH.D.NPI 1932339157

Title

Member

Phone

(888) 342-6002

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Vincent Grudberg, PH.D.

  • Clinical Psychologist
  • Maspeth, NY
  • NPI 1932339157
  NPD Authorized official

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

{
    "created_epoch": "1333929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333929600000",
    "number": "1679839229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4098",
            "city": "WOODBRIDGE",
            "state": "CT",
            "postal_code": "065250298",
            "telephone_number": "888-342-6002",
            "fax_number": "347-344-6594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 ORANGE ST",
            "address_2": "SUITE 1",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065116424",
            "telephone_number": "888-342-6002",
            "fax_number": "347-344-6594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PSYCHOLOGY OF CONNECTICUT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-09",
        "last_updated": "2012-04-09",
        "status": "A",
        "authorized_official_last_name": "GRUDBERG",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "888-342-6002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "3139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Signy M Peck, LCSW
• Earlene Jane Peckham, APRN,CPNP,MSN
• Marie Elisabeth Peddinghaus, MD
• Pediatric & Medical Associates, P.C.
• Pediatric Dentistry Associates, LLC
• Prachi Mangesh Pednekar, M.D.
• Caroline J Peh, PA
• Aldo Jose Peixoto, MD
• Richard R Pelker, MD
• Elizabeth Pellegrino, LCSW

• Clinical Psychologist in New Haven, CT
• Providers in New Haven, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.