Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 015340-1 | NY |
Y | 103TC0700X | Clinical Psychologist | 015340-1 | NY |
N | 103TC1900X | Counseling Psychologist | 015340-1 | NY |
NPI | 1083709943 |
---|---|
Provider Name | Dr. Kerry Kathleen Grohman |
First Address | Amherst, NY 14226-4648 |
Second Address | Buffalo, NY 14215-1129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 29/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02407041 | (05) | NY |
P70018 | (02) | NY |