Provider Demographics
NPI:1407358401
Name:GRUBER DILLARD, ELISABETH J (LISW)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:J
Last Name:GRUBER DILLARD
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932909
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-2909
Mailing Address - Country:US
Mailing Address - Phone:330-854-4281
Mailing Address - Fax:330-854-0032
Practice Address - Street 1:1700 BOETTLER RD STE 100
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7793
Practice Address - Country:US
Practice Address - Phone:330-896-0009
Practice Address - Fax:330-896-0032
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.18008491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical