NPI 1144973322 · live from the CMS NPI Registry
Thalia A Grundstrom, BCBA
Behavior Analyst in Bangor, ME. National Provider Identifier 1144973322, active.
NPI record
| NPI | 1144973322 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Behavior Analyst 103K00000X |
| Practice location | 396 Griffin Rd, Bangor, ME 04401 |
| Practice phone | 207-930-8129 |
| Mailing address | 760 Union St Ste A, Bangor, ME 04401 |
| Enumerated | January 28, 2022 |
| Last updated | January 28, 2022 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Behavior Analyst primary | 103K00000X | 1-20-46683 (NH) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.