Provider Demographics
NPI:1053712752
Name:GRUPENHOFF, JUDITH (MS, MED, NBC-HWC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:GRUPENHOFF
Suffix:
Gender:F
Credentials:MS, MED, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RESEARCH DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2178
Mailing Address - Country:US
Mailing Address - Phone:413-549-8400
Mailing Address - Fax:413-549-8409
Practice Address - Street 1:17 RESEARCH DRIVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2178
Practice Address - Country:US
Practice Address - Phone:413-549-8400
Practice Address - Fax:413-549-8409
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1629062906Medicaid