Provider Demographics
NPI:1154602506
Name:GRUBER BARZILOSKI, JEAN MARIE (MS, LPC, RD, LDN)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIE
Last Name:GRUBER BARZILOSKI
Suffix:
Gender:F
Credentials:MS, LPC, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1847
Mailing Address - Country:US
Mailing Address - Phone:470-470-4826
Mailing Address - Fax:
Practice Address - Street 1:840 MAIN ST
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1847
Practice Address - Country:US
Practice Address - Phone:570-470-4826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004646133V00000X
PAPC008357101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered