Healthcare Provider Details

I. General information

NPI: 1619647682
Provider Name (Legal Business Name): MARISA N GRUBER BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 UNIVERSITY RESEARCH CT STE 2000
COLLEGE PARK MD
20737-0019
US

IV. Provider business mailing address

11522 DEBORAH DR
POTOMAC MD
20854-3707
US

V. Phone/Fax

Practice location:
  • Phone: 240-923-4944
  • Fax:
Mailing address:
  • Phone: 248-990-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA114
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: