Active NPI
Martin Grebel, PH.D.
- Clinical Psychologist
- Madison, CT
National Provider Identifier
1982769667
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 000433
- Practice address
- 21 Kingsbridge Way
Madison, CT 06443-3407 - Phone
- (203) 605-7591
- Fax
- (860) 443-5990
- NPI assigned
- Dec 24, 2006
- Last updated
- Mar 17, 2023
- Sex
- Male
- 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 Psychologist | 103TC0700X | 000433 | CT | Primary |
Addresses
Primary practice location
21 Kingsbridge Way
Madison, CT 06443-3407
Mailing address
21 Kingsbridge Way
Madison, CT 06443-3407
Phone (203) 605-7591
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101210000630 | CT | Practitioner - Clinical Psychologist | 6800083288 | Practice locations: New London, CT |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1970
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
358 Montauk Ave
New London, CT 06320-4706
Phone 86044313962083
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000433 | CT | MD | Audiologist-Hearing Aid Fitter |
| 433 | CT | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679011200000",
"number": "1982769667",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 KINGSBRIDGE WAY",
"city": "MADISON",
"state": "CT",
"postal_code": "064433407",
"telephone_number": "203-605-7591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 KINGSBRIDGE WAY",
"city": "MADISON",
"state": "CT",
"postal_code": "064433407",
"telephone_number": "203-605-7591",
"fax_number": "860-443-5990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREBEL",
"first_name": "MARTIN",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-24",
"last_updated": "2023-03-17",
"certification_date": "2023-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "000433",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.