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General NPI Number Information
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NPI Number | 1851794382
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Entity Type | Organization
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Legal Business Name | DR. ROBERT A GRUENBERG
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Dates
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Enumeration Date | 09/29/2014
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 6213 N GREEN BAY AVE.
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City | MILWAUKEE
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State | WI
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Zip | 53209-3823
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Country | US
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Telephone | 414-352-1144
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Fax | 414-352-1133
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Provider Business Mailing Address
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Address Line | 6312 N GREEN BAY AVE.
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City | MILWAUKEE
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State | WI
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Zip | 53209
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Country | US
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Telephone | 414-352-1144
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Fax | 414-352-1133
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ROBERT A GRUENBERG
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Credential | PSY.D.
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Telephone | 414-352-1144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1294
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License Number State | WI
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