Provider Demographics
NPI:1285897082
Name:GRUBER, GWEN ROBIN (LCSW)
Entity type:Individual
Prefix:MS
First Name:GWEN
Middle Name:ROBIN
Last Name:GRUBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:
Other - Last Name:GRUBER NARDULLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15065 N 49TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254
Mailing Address - Country:US
Mailing Address - Phone:602-787-2960
Mailing Address - Fax:
Practice Address - Street 1:4202 N 32ND ST
Practice Address - Street 2:SUITE J TRASNFORMATION INSTITUTE
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018
Practice Address - Country:US
Practice Address - Phone:602-670-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 124451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical