Active NPI
Laurie Blum Grunebaum, PH.D.
- Psychologist
- New Haven, CT
National Provider Identifier
1760567671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 001747
- Practice address
- 62 Trumbull St
New Haven, CT 06510-1022 - Phone
- (203) 776-3667
- Fax
- (203) 772-1482
- NPI assigned
- Oct 26, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 001747 | CT | Primary |
Addresses
Primary practice location
62 Trumbull St
New Haven, CT 06510-1022
Mailing address
62 Trumbull St
New Haven, CT 06510-1022
Phone (203) 776-3667
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 134296 | Other | CT | VALUE OPTIONS |
| 060001747CT01 | Other | CT | ANTHEM BC & BS |
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001747 | CT | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760567671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "62 TRUMBULL ST",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065101022",
"telephone_number": "203-776-3667",
"fax_number": "203-772-1482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "62 TRUMBULL ST",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065101022",
"telephone_number": "203-776-3667",
"fax_number": "203-772-1482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRUNEBAUM",
"first_name": "LAURIE",
"middle_name": "BLUM",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CT",
"license": "001747",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "134296",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC & BS",
"identifier": "060001747CT01",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.