Provider Demographics
NPI:1316068141
Name:GRUBE, JENNIFER A (LCSW, CSWM)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:GRUBE
Suffix:
Gender:F
Credentials:LCSW, CSWM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-1804
Mailing Address - Country:US
Mailing Address - Phone:610-597-7200
Mailing Address - Fax:610-588-9880
Practice Address - Street 1:1031 W LINDEN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3988
Practice Address - Country:US
Practice Address - Phone:610-597-7200
Practice Address - Fax:610-588-9880
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0151281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical