Healthcare Provider Details

I. General information

NPI: 1689233595
Provider Name (Legal Business Name): KIMBERLY ANN GRUBER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 EASTON RD STE 5A
WARRINGTON PA
18976-2853
US

IV. Provider business mailing address

1432 EASTON RD STE 5A
WARRINGTON PA
18976-2853
US

V. Phone/Fax

Practice location:
  • Phone: 484-685-0965
  • Fax:
Mailing address:
  • Phone: 610-892-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC011436
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC011436
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: