Provider Demographics
NPI:1235360702
Name:GRUBB, MICHAEL L (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:GRUBB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 CASTRO ST # 675
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2512
Mailing Address - Country:US
Mailing Address - Phone:415-498-0761
Mailing Address - Fax:
Practice Address - Street 1:459 FULTON ST STE 102
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4364
Practice Address - Country:US
Practice Address - Phone:415-498-0761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29430103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical