MEDICARE: JUDITH F GRUBER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TP2701X	Group Psychotherapy Psychologist

General Provider Information

NPI Number	:	1215053038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDITH F GRUBER

Provider Business Mailing Address
First Line	:	141 JORALEMON ST APT 2B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4010
Country	:	US
Telephone Number	:	718-722-7907
Fax Number	:	718-222-9338

Provider Business Practice Location Address
First Line	:	141 JORALEMON ST APT 2B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4010
Country	:	US
Telephone Number	:	718-722-7907
Fax Number	:	718-222-9338

Authorized Official
Title or Position	:	PRESIDENT AND FOUNDER
Name	:	MS. JUDITH F. GRUBER
Credential	:	LCSW, CCET
Telephone Number	:	718-722-7907

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	06/20/2008

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