Provider Demographics
NPI:1174972780
Name:HOLTHAUSEN, GRECHEN
Entity type:Individual
Prefix:
First Name:GRECHEN
Middle Name:
Last Name:HOLTHAUSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 GRAVES AVE
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2626
Mailing Address - Country:US
Mailing Address - Phone:203-453-8047
Mailing Address - Fax:203-453-8044
Practice Address - Street 1:36 GRAVES AVE
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2626
Practice Address - Country:US
Practice Address - Phone:203-453-8047
Practice Address - Fax:203-453-8044
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT29861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical