Healthcare Provider Details

I. General information

NPI: 1336049055
Provider Name (Legal Business Name): STEVE GRUE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2026
Last Update Date: 11/06/2026
Certification Date: 11/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 MARIPOSA AVE
BERKELEY CA
94707-2444
US

IV. Provider business mailing address

1090 MARIPOSA AVE
BERKELEY CA
94707-2444
US

V. Phone/Fax

Practice location:
  • Phone: 925-245-2515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: