Provider Demographics
NPI:1336669563
Name:GRUBER, ILENE ABIGAIL (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:ILENE
Middle Name:ABIGAIL
Last Name:GRUBER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7821 FAULKNER RD
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-3246
Mailing Address - Country:US
Mailing Address - Phone:240-832-8430
Mailing Address - Fax:
Practice Address - Street 1:1114 BENEFIELD BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108
Practice Address - Country:US
Practice Address - Phone:410-987-4301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical