Healthcare Provider Details

I. General information

NPI: 1881626729
Provider Name (Legal Business Name): MARLENE ELAINE GRUVER L.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 JAVIT CT
AUSTINTOWN OH
44515-2409
US

IV. Provider business mailing address

6948 MEANDER RESERVE CT
CANFIELD OH
44406-8680
US

V. Phone/Fax

Practice location:
  • Phone: 330-797-4050
  • Fax: 330-797-4090
Mailing address:
  • Phone: 330-533-7973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS0018034
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: