Healthcare Provider Details

I. General information

NPI: 1033550397
Provider Name (Legal Business Name): GINETTE GRUBE PSYD, MP, RXP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74-03 COMMONWEALTH BLVD, MID-CHILDHOOD CLINIC, BLDG 55
BELLEROSE NY
11426-1839
US

IV. Provider business mailing address

7403 COMMONWEALTH BLVD
BELLEROSE NY
11426-1839
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number020108
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number325102
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0000008
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: